Abstract
Access to public open space is important to increase leisure-time walking (LTW) in high-income countries, but there is little evidence in middle-income countries. We conducted a cross-sectional analysis to examine the relationship between LTW and the presence of different public open spaces (parks, bike paths, and squares) and the mix of these recreational destinations near the homes of adults participating in the Sao Paulo Health Survey (n = 3145). LTW was evaluated by a questionnaire. We delineated buffers (500, 1000, and 1500 m) from the geographic coordinates of the adults' residential addresses using a geographic information system. We used multilevel logistic regression taking account of clustering by census tracts and households, and with adjustment for social, demographics, and health characteristics. The main results showed that the presence of at least two recreational destinations within a 500-m buffer of participants' homes were associated with an increased odds of LTW compared with no destinations present (OR = 1.65; 95% CI 1.09-2.55). No associations were found for destinations further away. These results support actions outlined in the new urban plan for Sao Paulo city and could be used to highlight the importance access to a mix of public open spaces to promote physical activity in megacities of middle-income countries.