Peer-reviewed article
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, Fatemeh Abavisani, Baylis Wright et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review examined 39 studies on how the presence and quality of sidewalks relates to children's physical health. Most research was conducted in North America using cross-sectional designs. Sidewalk availability and quality were consistently linked to higher physical activity levels and outdoor play in children, but the connection to weight-related outcomes was inconsistent.
Key points
- Sidewalk presence and quality were consistently associated with higher levels of physical activity, active transportation, and outdoor play in children
- Most frequently analyzed health outcomes were physical activity (23 studies), followed by BMI or weight-related measures (11 studies)
- The majority of included studies employed cross-sectional designs
- Most studies were based in North America, though research was conducted in diverse geographic regions
- Associations with weight-related outcomes were inconsistent across studies
Limitations
The review does not identify specific countries beyond noting a North American concentration, and most studies used cross-sectional designs which cannot establish causation. The review cannot determine whether sidewalk improvements directly cause increases in physical activity or if other factors are involved.
Abstract
BACKGROUND: This systematic review synthesized existing research about associations between sidewalk availability and quality and children's physical health outcomes. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.