Characteristics of the built environment associated with leisure-time physical activity among adults in Bogotá, Colombia: a multilevel study.
ABSTRACT Even though there is increasing evidence that the built environment (BE) has an influence on leisure-time physical activity (LTPA), little is known about this relationship in developing countries. The objective of this study was to assess the associations between objective built environment characteristics and LTPA.
A cross-sectional multilevel study was conducted in 27 neighborhoods in which 1315 adults aged 18-65 years were surveyed. An adapted version of the IPAQ (long version) was used to assess LTPA. Objective BE characteristics were obtained using Geographic Information Systems. Associations were assessed using multilevel polytomous logistic regression.
Compared with inactive people, those who resided in neighborhoods with the highest tertile dedicated to parks (7.4% to 25.2%) were more likely to be regularly active (POR = 2.05, 95% CI = 1.13-3.72; P = 0.021). Those who resided in neighborhoods with presence of TransMilenio stations (mass public transportation system) were more likely to be irregularly active (POR = 1.27, 95% CI = 1.07-1.50, P = 0.009) as compared with inactive people.
These findings showed that park density and availability of TransMilenio stations at neighborhood level are positively associated with LTPA. Public health efforts to address physical inactivity should consider the potential influences of urban planning and mass public transportation systems on health.
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ABSTRACT: Estimates of the burden of mortality associated to physical inactivity (PI) have not been quantified for large urban centers located in developing countries. To estimate the burden of mortality due to six chronic diseases (CDZ) associated to PI and the number of potentially preventable deaths associated to reductions in the prevalence of PI. PI exposure prevalence obtained via population surveys was linked to mortality data registered during 2002 among adult (> 45 y) Bogotá residents. The strength of association between PI and disease-specific mortality was obtained from the literature. Population attributable risk (PAR) was used to calculate the CDZ mortality attributable to PI and to estimate the number of potentially preventable deaths associated to a 30 % reduction in the prevalence of PI. A 53,2 % PI exposure prevalence was associated to a PAR of 19,3 % for coronary artery disease, 24,2 % for stroke, 13,8 % for arterial hypertension, 21 % for Diabetes Mellitus, 17,9 % for colon cancer and 14,2 % for breast cancer. An estimated 7,6 % of all-cause mortality and 20,1 % of CDZ mortality could be attributed to PI. An estimated 5% of the CDZ mortality could be prevented if PI prevalence is reduced by 30 %. Conservative estimates indicate that a considerable proportion of deaths due to highly prevalent CDZ could be attributed to PI. Strategies to reduce the prevalence of PI in Bogotá could lead to progressive reductions in the burden of CDZ mortality.Revista de salud publica (Bogota, Colombia) 01/2007; 8 Suppl 2:28-41.
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ABSTRACT: Evidence for an independent role of increased physical activity in the primary prevention of coronary heart disease has grown in recent years. The authors apply the techniques of meta-analysis to data extracted from the published literature by Powell et al. (Ann Rev Public Health 1987;8:253-87), as well as more recent studies addressing this relation, in order to make formal quantitative statements and to explore features of study design that influence the observed relation between physical activity and coronary heart disease risk. They find, for example, a summary relative risk of death from coronary heart disease of 1.9 (95% confidence interval 1.6-2.2) for sedentary compared with active occupations. The authors also find that methodologically stronger studies tend to show a larger benefit of physical activity than less well-designed studies.American Journal of Epidemiology 11/1990; 132(4):612-28. · 4.78 Impact Factor
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ABSTRACT: The aim of this paper is to examine whether physical activity plays any role in the prevention of cancer. To accomplish this, data from published epidemiologic studies on the relation between physical activity and the risk of developing cancer were reviewed. The data are clear in showing that physically active men and women have about a 30-40% reduction in the risk of developing colon cancer, compared with inactive persons. Although the data are sparse, it appears that 30-60 min.d(-1) of moderate- to vigorous-intensity physical activity is needed to decrease risk. There is a dose-response relation, with risk declining further at higher levels of physical activity. It is also clear that physical activity is not associated with the risk of developing rectal cancer. With regard to breast cancer, there is reasonably clear evidence that physically active women have about a 20-30% reduction in risk, compared with inactive women. It also appears that 30-60 min.d(-1) of moderate- to vigorous-intensity physical activity is needed to decrease the risk of breast cancer, and that there is likely a dose-response relation. For prostate cancer, the data are inconsistent regarding whether physical activity plays any role in the prevention of this cancer. There are relatively few studies on physical activity and lung cancer prevention. The available data suggest that physically active individuals have a lower risk of lung cancer; however, it is difficult to completely account for cigarette smoking. There is little information on the role of physical activity in preventing other cancers. Physical activity is associated with lower risk of developing certain site-specific cancers, in particular colon and breast cancers.Medicine & Science in Sports & Exercise 12/2003; 35(11):1823-7. · 4.48 Impact Factor
Gomez and Mosquera are with the División de salud, Fundacion
FES Social, Bogota, Colombia. Gomez is also with the Fac-
ultad de medicina, Universidad Javeriana, Bogota, Colombia.
Sarmiento is with the Dept of Social Medicine, Universidad
de los Andes, Bogota, Colombia. Parra is with the Prevention
Research Center in St. Louis and the George Warren Brown
School of Social Work, Washington University in St. Louis.
Schmid, Pratt, Neiman, and Rutt are with the Division of
Nutrition and Physical Activity, Centers for Disease Control
and Prevention, Atlanta, GA. Jacoby is with the Dept of
Healthy Eating and Active Living, Non-communicable Disease
Unit, Pan American/World Health Organization, Washington,
D.C. Cervero is with the Dept of City and Regional Planning,
University of California, Berkeley, Berkeley, CA. Ardila and
Pinzón are with the Centro de Estudios Urbanos, Corporación
de Universidades del Centro de la Ciudad, Bogota, Colombia.
Journal of Physical Activity and Health, 2010, 7(Suppl 2), S196-S203
© 2010 Human Kinetics, Inc.
Characteristics of the Built Environment Associated
With Leisure-Time Physical Activity Among Adults
in Bogotá, Colombia: A Multilevel Study
Luis F. Gomez, Olga L. Sarmiento, Diana C. Parra, Thomas L. Schmid, Michael Pratt,
Enrique Jacoby, Andrea Neiman, Robert Cervero, Janeth Mosquera,
Candance Rutt, Mauricio Ardila, and José D. Pinzón
Background: Even though there is increasing evidence that the built environment (BE) has an influence on
leisure-time physical activity (LTPA), little is known about this relationship in developing countries. The
objective of this study was to assess the associations between objective built environment characteristics and
LTPA. Methods: A cross-sectional multilevel study was conducted in 27 neighborhoods in which 1315 adults
aged 18–65 years were surveyed. An adapted version of the IPAQ (long version) was used to assess LTPA.
Objective BE characteristics were obtained using Geographic Information Systems. Associations were assessed
using multilevel polytomous logistic regression. Results: Compared with inactive people, those who resided
in neighborhoods with the highest tertile dedicated to parks (7.4% to 25.2%) were more likely to be regularly
active (POR = 2.05, 95% CI = 1.13–3.72; P = 0.021). Those who resided in neighborhoods with presence of
TransMilenio stations (mass public transportation system) were more likely to be irregularly active (POR =
1.27, 95% CI = 1.07–1.50, P = 0.009) as compared with inactive people. Conclusions: These findings showed
that park density and availability of TransMilenio stations at neighborhood level are positively associated with
LTPA. Public health efforts to address physical inactivity should consider the potential influences of urban
planning and mass public transportation systems on health.
Keywords: urban health, active living, public parks
The promotion of physical activity has been iden-
tified as an important strategy for facing the growing
epidemic of chronic diseases.1 According to the World
Health Organization, the burden of chronic diseases is
growing and 80% of worldwide mortality due to chronic
diseases occurs in low and middle-income countries,
generating premature deaths as well as significant social
and economic burdens.2 Colombia and its capital city of
Bogotá are not exceptions, as chronic diseases such as
coronary heart disease, stroke, and cancer are among the
leading causes of mortality.3,4
Despite the recognized health benefits of regular
physical activity5–7 the majority of the adult population
in Bogota is inactive.8 In fact, the last National Nutrition
Survey from Colombia reported that 44.7% of the adult
population in Bogotá met recommendations for physical
activity and only 8.6% met these criteria during leisure
time.8 Prevalence of leisure time physical activity (LTPA)
was even lower among women, people with low education
levels, and those who resided in poor and disadvantaged
Promotion of LTPA has special relevance for public
health because of its well-established physical and mental
health benefits.9 LTPA has been strongly associated
with perception of wellness and quality of life10,11 and it
may also contribute to social interactions that can bring
about better community cohesion and increased social
Ecological models emphasize the links between
policy and environmental attributes with the promotion
of physical activity.14 In addition, studies conducted by
Built Environment and PA in Bogotá S197
transportation and urban planners have made important
contributions to the knowledge of which attributes of the
built environment are associated with active transporta-
tion (ie, walking and cycling).
In the “3D” model developed by Cervero and
Kockelman, characteristics of the built environment
are grouped in 3 dimensions: density, diversity, and
design.15 According to this model, people who reside in
high-density neighborhoods have more opportunities to
access destinations that encourage nonmotorized means
of transportation. Diversity is related to mix land use and
people who reside in neighborhoods with high diversity
are more likely to walk or bike for transportation. Attri-
butes of design include connectivity, density of road
networks, and presence of parks and trees, among other
characteristics.15 To date, most research has explored
the association between these 3 attributes of design with
active transportation.14 The factors that promote and
motivate LTPA may differ from those that promote or
discourage utilitarian physical activity. However, they
may also be influenced by different combinations of
personal and environmental factors.15,16
Objective indicators obtained using geographic
information systems (GIS), including proximity to parks,
have been positively associated with meeting recommen-
dations for LTPA.17,18 In addition, a study conducted by
Ewing et al, which used a sprawl index calculated from
indicators of land use and street networks identified a
significant correlation between this index and minutes
walked during leisure time.19
Little is known about the association between
objective environmental characteristics and LTPA in the
Latin American region. A better understanding of these
connections in the context of the city of Bogotá will
provide valuable guidance for future efforts to promote
physical activity in the city and others urban settings in
Latin America. In consequence, this study examines the
associations between objective built environment char-
acteristics and LTPA among adults residing in the urban
area of Bogotá.
Bogotá, the capital city of Colombia, has a population
of approximately 7 million20 and is located on a plateau
at 2600 m above sea level. In the city, there have been a
number of efforts to create policies aimed at changing
social norms with the intention of increasing the mobility
of citizens and recover public space.21 For more than a
decade, one of the main goals for the city is to recognize
the rights of pedestrians, giving them priority over motor
The city has implemented a number of urban changes
that have included the construction of bicycle paths,
recovery of public spaces, creation and improvement of
public parks, and enhancement of existing recreational
programs.21 For example, from 2001 to 2003 Bogotá
increased the availability of green area per inhabitant
from 2.5 to 4.12 m2.21,22
The CicloRutas project is a network of approxi-
mately 300 km of bicycle paths. This network is in part
connected with one of the public transportation systems
of the city known as TransMilenio and with various parks
of the city.23 TransMilenio is a rapid mass transportation
system of buses that operate in exclusive lanes and have
fixed stations approximately every 500 m.21
Another initiative that has given recognition to the
city of Bogotá is the Ciclovía program in which 121 km of
the main avenues of the city are closed to motor vehicles
on Sundays and holidays from 6 AM to 2 PM and opened
solely for pedestrians and cyclists.21,23
Sample Areas and Study Population
A multistage, cross-sectional, multilevel study was car-
ried out during 2005 in the urban area of Bogotá among
30 neighborhoods selected as primary sampling units
(mean area, 447,204 m2; SD, 275,262 m2; min = 51,476
m2; max = 1,110,379 m2). To ensure representativeness
of community design, neighborhoods were selected after
a prior stratification by socioeconomic status (SES) (low
= 2, middle = 3–4, middle-high = 4), slope of the terrain
(average slope ≤10% vs >10%), proximity to TransMi-
lenio stations (≤500 ms vs >500 ms), and public park
provisions (≤6% of total land devoted to parks vs >6%).
The SES index was determined using the classification
from the Bogotá Planning Department based on physical
characteristics of the household and surrounding areas
(ie, conditions and accessibility of the roads, presence
of sidewalks, and construction materials of the house).
After sampling stratification, 2 cells did not have neigh-
Once the neighborhoods were selected, 5 blocks
were randomly selected in each neighborhood and 10
houses were randomly selected within each block. One
adult aged 18–65 years who had at least 1 year of resi-
dence was selected per household.
Due to small sample size in 3 neighborhoods of high
SES as a result of low response rates (0%–10%), only
27 neighborhoods with 1315 participants were finally
included in the study representing a response rate of
66%. Characteristics of each neighborhood are included
in Table 1.
All the protocols and questionnaires were reviewed
and approved the IRB of Universidad de los Andes
in Bogota. All the participants were asked to provide
informed consent before the survey.
A culturally adapted version of the long form of the
International Physical Activity Questionnaire (IPAQ)
was used to assess overall levels of physical activity by
domain including leisure time physical activity.24 Based
on previous experience in administering the IPAQ in
S198 Gomez et al
Table 1 List of the 27 Neighborhoods of the Study Population
with the Selected Characteristics Used in the Sampling Design
% area dedicated
to public parksd
a SES = socio-economic status.
b Average slope of the neighborhood was calculated in different topographic triangles in the terrain
levels and an average of these values was determined.
c Calculated as the existence of TransMilenio within the area of neighborhood.
d Park area/land area × 100.
Colombia and from results of cognitive interviews,25
changes in wording and the order of questions were made
to reduce over reporting of activity that has been found
in other IPAQ studies. In addition, the duration of activi-
ties in each of the days was also reported, which allowed
the calculation of a daily average of physical activity.
To validate the modified version of the long IPAQ, a
subsample of 41 persons wore accelerometers (Uniaxial
Computer Science and Application, Inc.’s accelerom-
eters, CSA-model-7164) for at least 5 days. We obtained
a Spearman correlation coefficient of 0.42 (P = .006)
between the scoring in metabolic equivalents (METS)
calculated from the IPAQ and the accelerometers. The
test-retest reliability of IPAQ was calculated among 147
adults and a Spearman correlation of 0.69 (P < .001) was
obtained. Methods used in this validation analysis were
consistent with the procedures followed by Craig et al26
and the measurement properties are comparable with
other validated questionnaires.27
For this analysis, 3 LTPA categories were defined:
regularly active (those who reported engaging in at least
30 minutes of LTPA per day for at least 5 days within the
Built Environment and PA in Bogotá S199
last 7 days), irregular active (those who reported at least
10 minutes of LTPA in the last 7 days, but did not meet
the criteria to be regularly active), and inactive (those who
reported less than 10 minutes of LTPA in the last 7 days).
Characteristics of the Built and Natural
Environment Measured by Geographical
Information Systems (GIS)
Measures of the built environment for this study were
developed with data from the Cadastre Department of
Bogota using Arc-View software (ArcInfo, version 9,
Redlands, CA, Environmental Systems). Characteristics
of the built environment were grouped in the 3 dimensions
described in the model developed by Cervero15: density,
diversity, and design. Using empirical evidence from
a previous study conducted in Bogotá,28 the following
neighborhood measures were selected: housing density,
land-use mix (index ranging from 0, which indicates
1 single land use, to 1 which indicates maximum het-
erogeneous land use), park density (percentage of land
covered by parks), and the presence of Ciclovía routes,
TransMilenio stations, and bicycle paths. In addition,
the slope of the terrain as a natural environment attribute
was included. Table 2 describes the operational definition
of each variable and their distribution within the study
We conducted analyses at both the block and the
neighborhood levels and found similar associations
between LTPA and built environment attributes with the
exception of park density which was only significant at
the neighborhood level. In this manuscript we focus on
the results from the neighborhood level analysis.
Covariates included gender, age groups (18–35 yrs, 36–50
yrs, and 51–65 years), and level of education (secondary
or less versus more than secondary).
Objective environmental characteristics were based on
the tertiles of the following indicators: housing density,
land use-mix and park density. New binary variables for
Ciclovía, TransMilenio and bicycle paths (present, not
present) were created.
Because the outcome variables of this study had 3
categories, a multilevel polytomous logistic regression
was conducted using HLM6.29 This analysis assumed a
random intercept form, and regression coefficients were
taken as fixed.30 Results were presented as odds ratios
with 95% confidence intervals. Environmental attributes
were included in the final model when the P value in
the bivariate analysis was less than 0.10. SES was not
Table 2 Environmental Measures Obtained by Geographic Information Systems (GIS)
in the Selected 27 Neighborhoods
Number of housing units/total number
of properties × 100
1 × ((Σi(pi)(lnpi))/lnk) where p = proportion
of total land uses, i = category of land use,
ln = natural logarithm, and
k = number of land-use categories
Park area/land area × 100
Total length in meters in neighborhood
Mean or %SD* VC**MinMax
61.9418.89 0.3010.46 85.94
24.50 Park density
Length of Ciclovíaa
of bicycle paths
162.22 321.86 1.980 979.3
Bicycle path km/street network km
1 or more
Average slope of the neighborhood was
calculated in different topographic triangles
in the terrain levels and an average of these
values was determined.
4.03 4.38 1.092 17.12
* SD = standard deviation.
** VC = variation coefficient.
a Ciclovía= Program in which 121 km of the main avenues of the city are closed to motor vehicles on Sundays and holidays and opened solely for
pedestrians and cyclists.
b Total number of TransMilenio stations in neighborhoods.
S200 Gomez et al
included in the model, as it was found to be significantly
correlated with education level. All the models were
adjusted for gender, age group, education level, slope
of the terrain and by the environmental attributes finally
Table 3 shows the sociodemographic characteristic of
the study population and the distribution of LTPA. The
mean age was 36 years (SD = 13.5), 43% of the sample
were between 18–35 years old. Sixty-five percent of
participants were women and 76% had more than second-
ary. Slightly more than 47% of the respondents engaged
in any leisure activity, and 9.2% were regularly active
during leisure time. The average time of residence in the
neighborhood for the total sample was 14.5 years.
Table 4 includes results from the multilevel poly-
tomous logistic regression models for being irregularly
and regularly active in leisure time. After adjustment for
covariates, the model showed that compared with inactive
people, those who resided in neighborhoods with a park
density between 7.4% and 25.2% were more likely to be
regularly active (OR = 2.05, 95% CI = 1.13–3.72). The
same positive association persisted for being irregularly
active but it was not significant at the ≤0.05 alpha level
(OR = 1.33, 95% CI = 0.99–1.78). As compared with
inactive people, those who resided in neighborhoods with
presence of TransMilenio stations were more likely to
be irregularly active (OR = 1.27, 95% CI = 1.07–1.50).
Finally, residing in a neighborhood with a slope of the
terrain of 4% or more, was negatively associated with
being regularly active during leisure time (OR = 0.37,
95% CI = 0.14–0.97).
This study found that park density and access to Trans-
Milenio were associated LTPA. In addition, living in a
neighborhood with a slope of the terrain of 4% or more
was negatively associated with being regularly active.
The positive association between availability of
parks and LTPA has been documented in several studies
and enhances the importance of public parks in the pro-
motion of active living in developing urban settings.17,18
The association between the presence of Trans-
Milenio stations and LTPA has been previously docu-
mented.28 This finding may be explained in part by the
urban interventions that have occurred alongside the
construction of TransMilenio, which include the enhance-
ment of pedestrian infrastructure such as sidewalks, cross
walks and pedestrian bridges.
To better interpret the results from this study it is
important to understand Bogotá’s cultural, economic, and
urban characteristics. Bogotá is a city with high levels
of housing density and land-use mix with relatively low
Table 3 Sociodemographic Characteristics of the Study Population and Distributions
of any Leisure-Time Physical Activity (LTPA) and Meeting Recommendations Through
LTPA Among 1315 Adults Aged 18–65 Years
Mean age (yrs)
Age groups (yrs)
(% or mean) (n = 1315)
36 (SD = 13.5)
(% or mean) (n = 619)
37.9 (SD = 14.2)
Regular active in LTPA
(% or mean) (n = 121)
41.2 (SD = 14.6)
Basic level (complete or incomplete)
Secondary (complete or in complete)
More than secondary
Years of residence in the neighborhood
14.5 (SD = 11.7) 14.2 (SD = 11.4)14.4 (SD = 10.4)
* P < .01.
** P < .001.
Table 4 Multilevel Polytomous Logistic Regression Analysis for Being Irregular and Regular
Active Versus Inactive in Leisure Time, Associated With Selected Built Environment Attributes
Among 1315 Adults Aged 18–65 Years
Slope of land
Less than 4% (referent)
4% or more
45.8 or less (referent)
Existence of bike paths
0.48 or less (referent)
4.3 or less (referent)
Existence of Ciclovíasa
Existence of TransMilenio stationsb
95% CIPORP PORP
0.71 (0.47–1.09)0.1100.24 (0.08–0.75)
1.15 (0.86–1.55)0.3421.90 (0.95–3.83)0.070
0.201 1.08(0.49–2.37) 0.844
Slope of land
Less than 4% (referent)
4% or more
Existence of bike paths
4.3 or less (referent)
Existence of TransMilenio stations
0.76 (0.48–1.19)0.2160.37 (0.14–0.97)
1.27 (1.07–1.50)0.0091.14 (0.46–2.84)0.764
a Ciclovía = program in which 121 km of the main avenues of the city are closed to motor vehicles on Sundays and holidays and opened solely for
pedestrians and cyclists.
b TransMilenio = transport system which operates in exclusive lanes and with fixed stations located every 500 meters.
Note. Participants in level 1 variables = 1315. Number of neighborhoods included in level 2 variables = 27.
S202 Gomez et al
variability in both of these characteristics. This could con-
tribute to explain the lack of association found with LTPA.
Several limitations of this study should be noted.
Some of the findings suggest that the study may have had
a reduced power to obtain precise confidence intervals
because of the modest sample size and the low response
rate among high SES neighborhoods. The cross-sectional
design of this study does not allow determining a causal
relationship between characteristics of the built environ-
ment and physical activity. This study cannot rule out
self-selection — for example, residents who want to be
active may select neighborhoods that provide easy access
to recreational opportunities, however, in the US similar
studies have reported that self-selection is only a partial
factor in explaining differential levels of activities.31
Taking into account that the majority of Bogota’s citizens
are from low or middle-low SES, and that the mean time
of residency was 14 years, the decision of where to live
may be more often based on economic factors rather
than environmental attributes . Finally, we did not find
associations between mix land-use and housing density.
This could be explained by the following factors: a) den-
sity and mix land use already have very high levels with
low variability; b) density was measured using housing
density instead of population density due to the fact that
the last census was conducted in 1993 and projections
of population growth for the time of the survey were not
accurate; as a result, population density could be even
higher; c) mix land use was calculated using information
from the Cadastro Department, however, there is a large
number of informal businesses that are not being captured
by this measurement (ie, street vendors); thus, land-use
mix could be even higher.
The survey instrument used in this study, which
relied on self-reported information, did not allow us to
determine which activities were carried out within or
outside the neighborhood, which may be a concern in
tying environmental attributes to LTPA. In addition, the
boundaries of the neighborhood were determined by the
city’s administrative considerations and did not necessar-
ily coincide with the perception of neighborhood bound-
aries that the study participants had. To better understand
the links between attributes of the built environment and
LTPA in the context of Latin American cities, new studies
and methodological approaches should be undertaken to
address these possible limitations.
Although the provision of public parks may affect
LTPA, factors such as the design of these parks, types
of use, and community appropriation are potentially
important. Researchers should consider including these
variables in future studies.
Results of this study also highlight the need to
expand and refine the measurement of physical activity to
include the possibility of identifying how environmental
factors outside the neighborhood may also have an influ-
ence on patterns of physical activity.
Despite the wide confidence intervals and the high
random errors for some of the associations identified in
this study, these findings have important relevance for
Bogota and for other cities from developing countries,
considering that small changes at the population level can
result in substantial public health benefits.32
To our knowledge this is the first study to explore
the links between objective characteristics of the built
environment and physical activity during leisure time in
a city from Latin America. It should be recognized as a
preliminary effort to understand this relationship in the
context of a developing country.
The multisectoral approach of this study, drawing
upon the knowledge and experience of experts from
public health, transportation, and urban design, may serve
as a template for future research addressing the complex
relationships between urban form and health. The findings
of this study suggest that public health efforts to address
physical inactivity and prevention of chronic disease in
urban areas of developing countries should include con-
sideration of the influences of urban planning and design
and transportation systems on health.
This study was supported by a grant from the International
Union for Health Promotion and Education and U.S. Centers
for Disease Control and Prevention. The findings and conclu-
sions in this report are those of the authors and do not neces-
sarily represent the views of the Centers for Disease Control
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