{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T18:40:18Z","timestamp":1760812818153,"version":"build-2065373602"},"reference-count":74,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2020,2,18]],"date-time":"2020-02-18T00:00:00Z","timestamp":1581984000000},"content-version":"unspecified","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004411","name":"Heart and Stroke Foundation of Canada","doi-asserted-by":"publisher","award":["G-17-0018638"],"award-info":[{"award-number":["G-17-0018638"]}],"id":[{"id":"10.13039\/100004411","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["CPP-137910","PJT-153449"],"award-info":[{"award-number":["CPP-137910","PJT-153449"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,2,3]]},"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Aspects of the built environment that support physical activity are associated with better population health outcomes. Few experimental data exist to support these observations. This protocol describes the study of the creation of urban trials on cardiovascular disease (CVD)-related morbidity and mortality in a large urban centre.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and analysis<\/jats:title>\n                  <jats:p>Between 2008 and 2010, the city of Winnipeg, Canada, built four, paved, multiuse (eg, cycling, walking and running), two-lane trails that are 5\u20138\u2009km long and span ~60 neighbourhoods. Linking a population-based health data with census and environmental data, we will perform an interrupted time series analysis to assess the impact of this natural experiment on CVD-related morbidity and mortality among individuals 30\u201365 years of age residing within 400\u20131200 m of the trail. The primary outcome of interest is a composite measure of incident major adverse CVD events (ie, CVD-related mortality, ischaemic heart disease, stroke and congestive heart failure). The secondary outcome of interest is a composite measure of incident CVD-related risk factors (ie, diabetes, hypertension and dyslipidaemia). Outcomes will be assessed quarterly in the 10 years before the intervention and 5\u2009years following the intervention, with a 4-year interruption. We will adjust analyses for differences in age, sex, ethnicity, immigration status, income, gentrification and other aspects of the built environment (ie, greenspace, fitness\/recreation centres and walkability). We will also assess trail use and trail user profiles using field data collection methods.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Ethics and dissemination<\/jats:title>\n                  <jats:p>Ethical approvals for the study have been granted by the Health Research Ethics Board at the University of Manitoba and the Health Information Privacy Committee within the Winnipeg Regional Health Authority. We have adopted an integrated knowledge translation approach. Information will be disseminated with public and government partners.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>\n                     <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT04057417\">NCT04057417<\/jats:ext-link>.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-036602","type":"journal-article","created":{"date-parts":[[2020,2,19]],"date-time":"2020-02-19T04:27:51Z","timestamp":1582086471000},"page":"e036602","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Physical activity trails in an urban setting and cardiovascular disease morbidity and mortality in Winnipeg, Manitoba, Canada: a study protocol for a natural experiment"],"prefix":"10.1136","volume":"10","clinical-trial-number":[{"clinical-trial-number":"nct04057417","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Erin","family":"Hobin","sequence":"first","affiliation":[{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anders","family":"Swanson","sequence":"additional","affiliation":[{"name":"Winnipeg Trails, Winnipeg, Manitoba, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gillian","family":"Booth","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly","family":"Russell","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4867-869X","authenticated-orcid":false,"given":"Laura C","family":"Rosella","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brendan T","family":"Smith","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ed","family":"Manley","sequence":"additional","affiliation":[{"name":"The Bartlett Centre for Advanced Spatial Analysis (CASA), University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wanrudee","family":"Isaranuwatchai","sequence":"additional","affiliation":[{"name":"Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie","family":"Whitehouse","sequence":"additional","affiliation":[{"name":"Active Transportation, City of Winnipeg, Winnipeg, Manitoba, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Brunton","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3741-5248","authenticated-orcid":false,"given":"Jonathan","family":"McGavock","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,2,18]]},"reference":[{"key":"2025101811183158000_10.2.e036602.1","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1016\/S0140-6736(16)30581-5","article-title":"Progress in physical activity over the Olympic quadrennium","volume":"388","author":"Sallis","year":"2016","journal-title":"Lancet"},{"key":"2025101811183158000_10.2.e036602.2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.969022"},{"key":"2025101811183158000_10.2.e036602.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2011.11.034"},{"key":"2025101811183158000_10.2.e036602.4","doi-asserted-by":"crossref","unstructured":"Frank LD , Kavage S , Devlin A . 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