The health of entire communities can be shaped by how we plan neighborhoods. When more than half the world now lives in urban areas, it is more important than ever to design streets and parks that encourage walking, running, and cycling.

A review of large, population-based studies shows how active cities are linked to improved health.

A study of 14 cities in 10 countries found that people living in neighborhoods that are easy to walk and have transit options other than driving get nearly 90 minutes of exercise per week.

The authors admit that there may be bias in the results. People who are fit might choose to live in areas that suit their interests. Poor walkability in some neighborhoods might be related to the link between health and socio-economic status.

Studies that examined how individual activity changes when people move houses also found evidence that greater access to shops, paths, parks, and public transport can lead someone to perform upwards of 16 additional minutes of physical activity per week.

Although studies comparing physical activity and urban design are important, another line of inquiry is how this extra activity impacts diabetes, hypertension, and cardiovascular health.

A study in Canada that included more than 30,000 people found that the prevalence of obese people in a high walkability area was 10 percentage points lower than in a low walkability area.

A study of 1.1 million healthy adults found that the likelihood of pre-diabetes developing over eight years was 20 percent higher in less active neighborhoods.

There may be an association between markers of glycemic control and walkability in an area. The reviewers say that few of the studies adequately controlled for race and status.

The markers of cardiovascular health appear more clearly impacted. A population-based study in Canada found that moving from an "unwalkable" neighborhood to a "Highly Walkable" one was linked to a 54 percent reduction in the development of high blood pressure over the course of a decade.

In Australia, the United States, and the United Kingdom, the results are supported by other population-based studies.

The authors of the review concluded that a large number of globally representative studies suggest that denser, more walking cities can help improve the health of a community.

Further research is still needed to tease apart other factors that can affect public health.

Although it is convenient to discuss the built environment's impact on health in isolation, there is a complex interplay between environmental exposures.

Air pollution levels, food environments, and natural features, like green space, may independently influence metabolic health and must be considered when isolating the effects of the built environment.

Some studies have found that access to green spaces can improve public health, but it's not clear if this is through physical exercise or something else.

Adding more green spaces to a city could reduce local air pollution and improve a population's physical health and well-being.

When people are offered the chance to get outside, they jump at the chance.

The study was published in a journal.