Olga L.Sarmiento. MD, MPH, PhD Adriana Díaz del Castillo H. MD, MAEthel Segura Durán. Arq., MG

Bogotá

A City with a Built Environment that Promotes Physical Activity. Promoting Healthy Living in the Americas: Multisectoral Interventions to reduce health risks factorsWashington, DC, November 18th, 2013

Photo: Diana Fernández

Context: physical inactivity and chronic diseases

Objectives Methods Case results: Ciclovía

Recreativa, CicloRutas, TransMilenio & Outdoor gyms

Lessons learned and recommendations

Agenda

Photo: Ethel Segura

26% 35%

Prevalence

Wen et al. 2012 ; Lee et al. 2012 ; Lobelo 2006

5.1 5.3

Annual deaths (global)

5.3MILLION

Deaths attributed to physical inactivity (PI) worldwide

Deaths attributed to PI in Colombia11.7

%

The burden of physical inactivity

All cause mortality attributed to PI in Bogotá

7.6%

Deaths due to NCD attributed to PI in Bogotá

20.1%

Ensin 2010 Sarmiento et al

Physical activity in Bogotá

Total Leisure time Walking for transport

Cycling for transport

0

10

20

30

40

50

60

7057.8

18.3

40.5

4.3

Meeting PA recommendations

%

objectives

Photo: Ethel Segura

Objectives

Describe the processes and stakeholders that led to the design and implementation of: Ciclovía Recreativa, CicloRutas, TransMilenio and

Outdor gyms as promising programs or infrastructures to promote physical activity in Bogotá.

Provide recommendations for the developing of similar policies, programs, and infrastructures in other cities.

methods

Photo: Olga Sarmiento

Literature review of the policy processes.

Document analysis of policies, regulations, legislative acts, and district development plans.

Semi-structure interviews. Secondary analysis of population

surveys (2005, 2010, 2011).

Methods

Photo: Ethel Segura

results

Photo: Ethel Segura

Ciclovía, CicloRutas, TransMilenio, and Parks Users’ Average Number of PA Minutes per Week

Ciclovia CicloRuta TransMilenio Park users Bogota0

50

100

150

200

250

300

350

400

450

500

202.4

142.7

303.3323.1

222.3

98.6

469.7

17.1 29.2 27.8

132.1102.3

70.2 79.6

23.3

Walking transport Cycling transport Leisure time moderate PA

Ciclovía

Week day Ciclovía

-113 km of streets-~70 events per year-600,000-1,200,000 participants per event

Sarmiento et al 2010; Montes et al. 2012; Torres et al 2013

Photo: Olga Sarmiento

Ciclovía & Physical ActivityAdults (18-64 yrs)

• 9.8% of the population reported participating in the last month • 59.5% of users meet PA recommendations (for leisure) • Ciclovía participants vs. no participants are more likely to meet PA

recommendations (POR:1.7; 95% CI 1.1-2.4); (POR: 7.4; 95% CI 4.0-13.8).• Ciclovia participants are more likely to bike for transportation OR 2.28

(1.32-3.94)• The cost–benefit ratio for health benefit from physical activity was 3.23–

4.26Older Adults (60-98yrs)• Access to Ciclovía was associated with having walked at least 150

minutes in a usual week (POR:1.29, 95% CI1.0, 1.7).Children (9-10 yrs)• 31.8% of the children reported participating at least once a month in the

Ciclovia• Ciclovia users have higher mean minutes of MVPA vs. non Ciclovia users

Beta= 3.047 p=0.03 Sarmiento et al 2010; Montes et al. 2012; Torres et al 2013; Gomez 2010

Ciclovía

Week day Ciclovía

-1974, started promoted by activists-1995, District Institute of Recreation and Sports-Program to reduce NCD in National Public Health Plan - Law on Obesity (1355) as a strategy to promote PA

Sarmiento et al 2010; Montes et al. 2012; Torres et al 2013

Photo: Olga Sarmiento

Stakeholders Activists-bike enthusiasts City government– mayors Transport Police Ministry Education IDRD Urban planning Health City residents Congress- City Council Private vehicle owners Businesses

Transport priorities Businesses Changed

government priorities

Favorable context Political will Alignment with

government plans Community

participation Multi-sectoral work Lead entity

BarriersFacilitators

Ciclovía

Multi sectorial Network of the Ciclovia

Meisel et al. 2013

Open Streets in the Americas

CicloRutas

Torres et al 2013; Ricaurte 2010

Photo: Ethel Segura

-Bike paths-344km in the network-Longest network in Latin America-83,436 users per day -Law on Obesity (1355) as a strategy to promote PA

CicloRutas70.5% of users meets PA recommendations (for transport)

Torres et al 2013; Ricaurte 2010

The cost–benefit ratio for health benefit from physical activity was 2.8

Photo: Ethel Segura

CicloRutasStakeholders BarriersFacilitators

City government JICA Urban planning (IDU) Public utility

companies: EAAB – ETB – Codensa

IDRD Police Bike activists

Non-integrated interventions Lack of comprehensive policies Lack of a lead entity Imbalance of transport priorities Low status of bicycles Circuit interruptions Road insecurity and crime Funding for maintenance

Favorable context Vision of the city:

sustainable transport Budget allocation Changes to roads

that supported the new infrastructure

TransMilenio-30% of the trips in Bogotá are made by public transport (9% TransMilenio)-TransMilenio buses operate in exclusive lanes with fixed stations ~500m-Average of 1.2million passengers per day-The fastest mode of transport 28km/h

Cervero et al. 2009

Photo: Andrea Ramírez

TransMilenio

Adults living in a neighborhood with 1 or 2 TM stations are more likely to walk for transport and meet PA recommendations than those who live in neighborhoods without TM stationsCervero et al. 2009

Photo: Andrea Ramírez

Physical activity &TransMilenio

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122230

0.51

1.52

2.53

3.54

Predicted MVPA minutes TM users

Predicted MVPA minutes non TM users

Hour

MVP

A m

inut

es p

er h

our

Relation between moderate and vigorous physical activity (MVPA) minutes per hour and time of day for users and nonusers of TransMilenio (N = 250).

>22 minutes daily of MVPA (PR = 1.36, CI = 95% [1.08-1.63]

Stakeholders BarriersFacilitators City government Urban planning Public transport

operators Private

concessionaires Media Urban planning

experts and academics

City residents

Problems in execution and operation

Reduced user satisfaction

Cost of the fare

Favorable context Political will Unsuccessful earlier

experiences Fixed stations

TransMilenio

• 120 cities• 280 corridors• 4,300 Km• 6,700 stations• 30,000 buses• 28 million

passengers/day

24

BRT around the world

Source: Hidalgo, D., & Gutiérrez, L., BRT and BHLS around the world: Explosive growth, large positive impacts and many issues outstanding, Research in Transportation Economics (2012)

Outdoor gyms

Among adults and older adults, park density and frequent use are associated with

meeting PA recommendations during leisure time

Gómez et al. 2010 (a) (b)

Photo: Olga Sarmiento

Outdoor gymsStakeholders BarriersFacilitators

Private company City residents IDRD

Funding Vandalism

Public-private partnerships with benefits for all

Community participation

Lessons learned

Multi-sectoral work. Use of existing infrastructure

to promote PA to optimize resources

Comprehensive interventions. Health sector needs to build

on other sectors initiatives. To promote sustainability—

common goals and active interactions among institutions.

Community participation & political will: both are necessary but neither is sufficient on its own.

Photo: Diana Fernández

Include the health sector in urban planning processes.

Include health indicators in the design, evaluation and monitoring of urban development programs.

Promote different dimensions of PA through comprehensive approaches.

Recommendations

Photo: Olga Sarmiento

Thank you

Photo: Ethel Segura