Testing the physical activity transition model among children and adolescents in low- and middle-income countries: a systematic review and meta-analysis
1
Faculty of Health Sciences, University of Lethbridge, Lethbridge, Canada
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
The Physical Activity (PA) Transition model suggests that urbanization leads to decreased PA levels, especially in urban areas. Currently, low- and middle-income countries (LMICs) are urbanizing rapidly, which can influence PA levels. However, existing evidence is based on individual country studies, limiting broad conclusions about the transition. This systematic review summarizes current research on the PA transition among children and adolescents in LMICs.
METHODS:
We screened 5,147 potentially relevant articles. Data were extracted from 84 studies across 29 countries, involving 530,908 participants aged between 3 and 19 years. Study quality was assessed using the AXIS or JBI tools. The GRADE approach was used to evaluate the quality of evidence. Data were synthesized narratively or meta-analyzed where appropriate. Meta-analyses compared device-based moderate-to-vigorous PA (MVPA) estimates between urban and rural participants.
RESULTS:
The qualitative synthesis showed that 68% of significant differences in PA levels favored rural participants. The main meta-analysis indicated that, on average, children in urban areas accumulated ten fewer minutes of MVPA daily compared to those in rural areas, representing about one-sixth of the WHO PA guidelines. Stratified analyses revealed that children and adolescents in urban areas of low- (MD = −16.08) and lower-middle income countries (MD = −9.48), as well as in Africa (MD = −12.29) and the Americas (MD = −8.45), accumulated significantly fewer MVPA minutes per day than their rural counterparts.
CONCLUSIONS:
Urbanization is associated with lower PA levels among children and adolescents in LMICs, with a small effect size (Cohen's d: −0.38, 95% CI: −0.58 to −0.18). This finding aligns with the PA transition model, which posits that urbanization leads to a decrease in PA levels, particularly in urban settings. As urban growth accelerates in LMICs, policymakers, public health professionals, and urban planners should prioritize designing cities that foster active living and support healthy lifestyles.
The Physical Activity (PA) Transition model suggests that urbanization leads to decreased PA levels, especially in urban areas. Currently, low- and middle-income countries (LMICs) are urbanizing rapidly, which can influence PA levels. However, existing evidence is based on individual country studies, limiting broad conclusions about the transition. This systematic review summarizes current research on the PA transition among children and adolescents in LMICs.
METHODS:
We screened 5,147 potentially relevant articles. Data were extracted from 84 studies across 29 countries, involving 530,908 participants aged between 3 and 19 years. Study quality was assessed using the AXIS or JBI tools. The GRADE approach was used to evaluate the quality of evidence. Data were synthesized narratively or meta-analyzed where appropriate. Meta-analyses compared device-based moderate-to-vigorous PA (MVPA) estimates between urban and rural participants.
RESULTS:
The qualitative synthesis showed that 68% of significant differences in PA levels favored rural participants. The main meta-analysis indicated that, on average, children in urban areas accumulated ten fewer minutes of MVPA daily compared to those in rural areas, representing about one-sixth of the WHO PA guidelines. Stratified analyses revealed that children and adolescents in urban areas of low- (MD = −16.08) and lower-middle income countries (MD = −9.48), as well as in Africa (MD = −12.29) and the Americas (MD = −8.45), accumulated significantly fewer MVPA minutes per day than their rural counterparts.
CONCLUSIONS:
Urbanization is associated with lower PA levels among children and adolescents in LMICs, with a small effect size (Cohen's d: −0.38, 95% CI: −0.58 to −0.18). This finding aligns with the PA transition model, which posits that urbanization leads to a decrease in PA levels, particularly in urban settings. As urban growth accelerates in LMICs, policymakers, public health professionals, and urban planners should prioritize designing cities that foster active living and support healthy lifestyles.
| eISSN: | 2654-1459 |
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