Systematic Review of the Relationship Between the Presence and Quality of Sidewalks and Children's Physical Health.
Farnaz Hesam Shariati, Jason Daniel Czerwinski, Sadaf Adhami et al.
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In 30 seconds
This systematic review examined associations between sidewalk availability or quality and physical health outcomes in children. It included 39 studies, identified from 17,726 records, using observational and experimental designs; most were cross-sectional and conducted in North America. Sidewalk presence and quality were consistently associated with higher levels of children’s physical activity, including active transportation and outdoor play. Associations with BMI or other weight-related outcomes were inconsistent. The review concludes that evidence is more consistent for activity behaviours than for weight-related outcomes and calls for stronger longitudinal and quasi-experimental research to improve causal inference.
Key findings
- Among 39 included studies, 23 examined physical activity, active transportation, or outdoor play; 11 examined BMI or weight-related measures, and 5 examined both.
- Sidewalk presence and quality were consistently associated with higher levels of various forms of children’s physical activity.
- Associations between sidewalk characteristics and children’s BMI or other weight-related outcomes were inconsistent.
- Most included studies used cross-sectional designs, limiting the strength of causal inference.
Why it matters
The review suggests that sidewalk infrastructure may be relevant to children’s opportunities for physical activity, while evidence linking it to weight outcomes is less consistent. Distinguishing these outcomes matters when interpreting built-environment research and considering how neighbourhood features relate to child health. More rigorous study designs and improved measurement of sidewalk attributes could clarify which features are associated with activity.
What to keep in mind
Most included studies were cross-sectional, and the review reports varied objective and subjective measures of sidewalk characteristics and health outcomes; causal inference is therefore limited.