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The impact of area-based initiatives on physical activity trends in deprived areas; a quasi-experimental evaluation of the Dutch District Approach

Daniëlle Kramer1*, Mariël Droomers1, Birthe Jongeneel-Grimen1, Marleen Wingen2, Karien Stronks1 and Anton E Kunst1

Author Affiliations

1 Department of Public Health, Academic Medical Centre, University of Amsterdam, PO Box 22660, Amsterdam, 1100 DD The Netherlands

2 Department of Social and Spatial Statistics, Statistics Netherlands, PO Box 4481, 6401 CZ Heerlen, The Netherlands

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International Journal of Behavioral Nutrition and Physical Activity 2014, 11:36  doi:10.1186/1479-5868-11-36

Published: 11 March 2014



Numerous area-based initiatives (ABIs) have been implemented in deprived neighbourhoods across Europe. These large-scale initiatives aim to tackle the socio-economic and environmental problems in these areas that might influence physical activity (PA). There is little robust evidence of their impact on PA. This study aimed to assess the impact of a Dutch ABI called the District Approach on trends in leisure-time PA in deprived districts.


Repeated cross-sectional data on 48401 adults across the Netherlands were obtained from the Integrated Survey on Household Living Conditions (POLS) 2004–2011. 1517 of these adults resided in deprived target districts and 46884 adults resided elsewhere in the Netherlands. In a quasi-experimental interrupted time-series design, multilevel logistic regression analyses were performed to assess trends in leisure-time walking, cycling, and sports before and during the intervention. Trends in deprived target districts were compared with trends in various control groups. The role of the intensity of environmental interventions was also assessed.


Deprived target districts showed a significantly positive change in walking trend between the pre-intervention and intervention period. The trend change in the deprived target districts was significantly larger compared to the rest of the Netherlands, but not compared to other deprived districts. For cycling and sports, neither deprived districts nor control districts showed a significant trend change. For all leisure-time PA outcomes, trend changes were not related to the intensity of environmental interventions in the deprived target districts.


Some evidence was found to suggest that ABIs like the District Approach have a positive impact on leisure-time PA in deprived districts, regardless of the intensity of environmental interventions.

Area-based initiatives; Evaluation; Physical activity; Quasi-experimental design; Deprivation