Associations Between the Built Environment and Physical Activity in Urban Asia: A Systematic Review

Background : Insufficient physical activity and excessive sedentary behavior are growing public health concerns in rapidly urbanizing Asian cities. Built environment characteristics may influence these behaviors, but region-specific evidence remains limited. This review synthesized associations between built environment characteristics and physical activity or sedentary behavior in urban Asia. Methods : Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO CRD42023396292), 5 databases (Ovid MEDLINE, Embase, Web of Science, Scopus, and Cochrane Library) were searched for English-language articles published between 2012 and 2024. Articles were included if they examined associations between built environment characteristics and physical activity or sedentary behavior among adults in urban areas of Asia. Statistically significant associations were synthesized descriptively. Results : Of 14,549 records screened, 98 articles from 13 countries met inclusion criteria, most using cross-sectional designs (96.9%). A total of 261 associations were identified, focusing on overall (37.9%), recreational (31.4%), and transport-related (29.9%) physical activity; only 2 associations (0.8%) addressed sedentary behavior. Supportive built environments were more often associated with increased physical activity (n = 208) than with decreased (n = 38). Overall physical activity was commonly associated with recreational facilities and land-use mix; recreational activity with recreational facilities and aesthetics; and transport-related activity with land-use mix and residential density. Conclusions : In urban Asia, 208 of 261 significant associations showed that supportive built environments were associated with increased physical activity. Land-use mix and access to recreational facilities were most consistently supportive. These findings highlight the need for context-sensitive urban planning and more research on sedentary behavior.