Effects of the built environment on physical activity of adults living in rural settings.

Objective: To conduct a systematic review of the literature to examine the influence of the built environment (BE) on the physical activity (PA) of adults in rural settings.
Data Source: Key word searches of Academic Search Premier, PubMed, CINAHL, Web of Science, and Sport Discus were conducted.
Study Inclusion and Exclusion Criteria: Studies published prior to June 2008 were included if they assessed one or more elements of the BE, examined relationships between the BE and PA, and focused on rural locales. Studies only reporting descriptive statistics or assessing the reliability of measures were excluded.
Data Extraction: Objective(s), sample size, sampling technique, geographic location, and definition of rural were extracted from each study. Methods of assessment and outcomes were extracted from the quantitative literature, and overarching themes were identified from the qualitative literature.
Data Synthesis: Key characteristics and findings from the data are summarized in Tables 1 through 3.
Results: Twenty studies met inclusion and exclusion criteria. Positive associations were found among pleasant aesthetics, trails, safety/crime, parks, and walkable destinations.
Conclusions: Research in this area is limited. Associations among elements of the BE and PA among adults appear to differ between rural and urban areas. Considerations for future studies include identifying parameters used to define rural, longitudinal research, and more diverse geographic sampling. Development and refinement of BE assessment tools specific to rural locations are also warranted.