Relationship between the physical environment and physical activity in older adults: A systematic review

Change in walking and body mass index following residential relocation: the multi-ethnic study of atherosclerosis

OBJECTIVES

We investigated whether moving to neighborhoods with closer proximity of destinations and greater street connectivity was associated with more walking, a greater probability of meeting the "Every Body Walk!" campaign goals (≥ 150 minutes/week of walking), and reductions in body mass index (BMI).

METHODS

We linked longitudinal data from 701 participants, who moved between 2 waves of the Multi-Ethnic Study of Atherosclerosis (2004-2012), to a neighborhood walkability measure (Street Smart Walk Score) for each residential location. We used fixed-effects models to estimate if changes in walkability resulting from relocation were associated with simultaneous changes in walking behaviors and BMI.

RESULTS

Moving to a location with a 10-point higher Walk Score was associated with a 16.04 minutes per week (95% confidence interval [CI] = 5.13, 29.96) increase in transport walking, 11% higher odds of meeting Every Body Walk! goals through transport walking (adjusted odds ratio = 1.11; 95% CI = 1.02, 1.21), and a 0.06 kilogram per meters squared (95% CI = -0.12, -0.01) reduction in BMI. Change in walkability was not associated with change in leisure walking.

CONCLUSIONS

Our findings illustrated the potential for neighborhood infrastructure to support health-enhancing behaviors and overall health of people in the United States.

Nature and health

Urbanization, resource exploitation, and lifestyle changes have diminished possibilities for human contact with nature in urbanized societies. Concern about the loss has helped motivate research on the health benefits of contact with nature. Reviewing that research here, we focus on nature as represented by aspects of the physical environment relevant to planning, design, and policy measures that serve broad segments of urbanized societies. We discuss difficulties in defining "nature" and reasons for the current expansion of the research field, and we assess available reviews. We then consider research on pathways between nature and health involving air quality, physical activity, social cohesion, and stress reduction. Finally, we discuss methodological issues and priorities for future research. The extant research does describe an array of benefits of contact with nature, and evidence regarding some benefits is strong; however, some findings indicate caution is needed in applying beliefs about those benefits, and substantial gaps in knowledge remain.

Ageing in an ultra-dense metropolis: perceived neighbourhood characteristics and utilitarian walking in Hong Kong elders

OBJECTIVE

The neighbourhood built environment may affect walking behaviour of elders. However, such effects remain underexplored, especially in an Asian context. We examined associations of perceived environmental attributes with overall and neighbourhood-specific walking for transport in a sample of Chinese elders residing in Hong Kong, an ultra-dense Chinese metropolis.

DESIGN

Cross-sectional observational study using a two-stage stratified sampling strategy.

SETTING

Hong Kong, China.

SUBJECTS

Chinese-speaking elders (n 484), with no cognitive impairment and able to walk without assistance, residing in thirty-two selected communities stratified by socio-economic status and walkability, were interviewer-administered validated measures of perceived neighbourhood environment and walking for transport.

RESULTS

Much higher levels of transport-related walking (mean 569 (sd 452) min/week) than found in Western samples were reported. The degree of perceived access to shops, crowdedness, presence of sitting facilities and easy access of residential entrance were independently positively related to both frequency of overall and within-neighbourhood walking for transportation. Infrastructure for walking and access to public transport were predictive of higher frequency of transport-related walking irrespective of location, while the perceived degree of land-use mix was predictive of higher levels of within-neighbourhood walking.

CONCLUSIONS

The provision of easy access to shops, residential entrances and sitting facilities in the neighbourhood may promote overall transport-related walking, while a good public transport network and pedestrian infrastructure linking destination-poor with destination-rich locations may compensate for the detrimental effects of living in less walkable neighbourhoods. Governmental investment in these micro- and macro-environmental features would help the promotion of an active lifestyle in elders.

Physical activity is medicine for older adults

There is evidence from high quality studies to strongly support the positive association between increased levels of physical activity, exercise participation and improved health in older adults. Worldwide, around 3.2 million deaths per year are being attributed to inactivity. In industrialised countries where people are living longer lives, the levels of chronic health conditions are increasing and the levels of physical activity are declining. Key factors in improving health are exercising at a moderate-to-vigorous level for at least 5 days per week and including both aerobic and strengthening exercises. Few older adults achieve the level of physical activity or exercise that accompanies health improvements. A challenge for health professionals is to increase physical activity and exercise participation in older adults. Some success in this has been reported when physicians have given specific, detailed and localised information to their patients, but more high quality research is needed to continue to address this issue of non-participation in physical activity and exercise of a high enough level to ensure health benefits.

Socioeconomic status, neighborhood characteristics, and walking within the neighborhood among older Hong Kong Chinese

OBJECTIVE

We examined the associations of educational attainment and area socioeconomic status (SES) with total within-neighborhood walking patterns and percentage of walking undertaken for recreation purposes in Hong Kong elders. Environmental mediators of these associations were also examined.

METHOD

Chinese-speaking elders (N = 484), cognitively unimpaired and able to walk unassisted, were recruited from 32 street blocks stratified by SES and walkability. Interviewer-administered surveys were conducted to collect data on walking and sociodemographics. Neighborhood environments were audited.

RESULTS

Educational attainment was positively related to walking outcomes, while area SES was only positively related to percentage of walking allocated to recreational purposes. While no mediators of area SES-walking associations were identified, several environmental attributes explained the associations of educational attainment with walking.

DISCUSSION

Educational attainment rather than area SES is a key determinant of walking in Hong Kong elders; these effects are mostly attributable to social and individual rather than environmental factors.

The impact of neighborhood walkability on walking: does it differ across adult life stage and does neighborhood buffer size matter?

We explored the impact of neighborhood walkability on young adults, early-middle adults, middle-aged adults, and older adults' walking across different neighborhood buffers. Participants completed the Western Australian Health and Wellbeing Surveillance System Survey (2003-2009) and were allocated a neighborhood walkability score at 200m, 400m, 800m, and 1600m around their home. We found little difference in strength of associations across neighborhood size buffers for all life stages. We conclude that neighborhood walkability supports more walking regardless of adult life stage and is relevant for small (e.g., 200m) and larger (e.g., 1600m) neighborhood buffers.

Association between the perceived environment and physical activity among adults in Latin America: a systematic review

BACKGROUND

Activity friendly environments have been identified as promising strategies to increase physical activity levels in the population. Associations between perceived environmental attributes and physical activity in Latin America may vary from those observed in high income countries. The objective of this systematic review is to identify which perceived environmental attributes are associated with physical activity in Latin America.

METHODS

Systematic literature search of articles published in English, Portuguese, and Spanish in four databases was conducted (PubMed, Virtual Health Library, EBSCO, and Web of Science). Associations with environmental attributes were analyzed separately for physical activity domains. Fifteen articles were included in the analysis.

RESULTS

All studies had cross-sectional designs. The majority of associations were statistically non-significant, and only four associations were found in the unexpected direction. Leisure-time and transport-related physical activity were the domains most frequently included in the studies and had higher number of associations in the expected direction. Leisure-time physical activity showed a convincing association in the expected direction with safety during the day. Transport-related physical activity had a convincing association with presence of street lighting.

CONCLUSIONS

This study shows that perceived environmental attributes and their relationship with physical activity appears to be domain, and context specific. In addition, findings from this study show inconsistencies with the information gathered from high-income countries.

Using remote sensing to define environmental characteristics related to physical activity and dietary behaviours: a systematic review (the SPOTLIGHT project)

We performed a systematic literature review on the use of free geospatial services as potential tools to assess built environmental characteristics related to dietary behaviour and physical activity. We included 13 studies, all published since 2010 and conducted in urban contexts, with Google Earth and Google Street View as the two main free geospatial services used. The agreement between virtual and field audit was higher for items related to objectively verifiable measures (e.g. presence of infrastructure and equipment) and lower for subjectively assessed items (e.g. aesthetics, street atmosphere, etc.). Free geospatial services appear as promising alternatives to field audit for assessment of objective dimensions of the built environment.

Physical activity preferences of early-stage lung cancer survivors

PURPOSE

Engagement in physical activity can provide important benefits for cancer patients and survivors, including those diagnosed with lung cancer. Despite this, many survivors do not engage in recommended levels of physical activity and little is known about the obstacles encountered by lung cancer survivors. The current study examines the physical activity preferences of early-stage lung cancer survivors.

METHOD

As part of a larger survey study, 175 non-small cell lung cancer survivors who were on average 3.6 years from surgical treatment responded to questions regarding their preferences for physical activity and physical activity advice. Demographic and medical characteristics were also collected.

RESULTS

The majority of respondents (62 %) reported a desire to receive advice regarding physical activity, predominantly before treatment (68 %), in face-to-face interactions (95 %) with a physician (80 %), and within the context of a cancer care center (92 %). Approximately half of participants indicated they would be interested in an exercise program tailored to lung cancer survivors and most individuals (73 %) reported feeling capable of engaging in an exercise program. Differences in physical activity preferences emerged based on demographic and disease characteristics.

CONCLUSIONS

The majority of participants reported a desire for physical activity advice and a willingness to engage in physical activity. Important differences were found based on demographic and medical characteristics, which may warrant consideration in the development and dissemination of physical activity interventions for this cancer survivor population.

Neighborhood environment and physical activity among older adults: do the relationships differ by driving status?

Some attributes of neighborhood environments are associated with physical activity among older adults. This study examined whether the associations were moderated by driving status. Older adults from neighborhoods differing in walkability and income completed written surveys and wore accelerometers (N = 880, mean age = 75 years, 56% women). Neighborhood environments were measured by geographic information systems and validated questionnaires. Driving status was defined on the basis of a driver's license, car ownership, and feeling comfortable to drive. Outcome variables included accelerometer-based physical activity and self-reported transport and leisure walking. Multilevel generalized linear regression was used. There was no significant Neighborhood Attribute × Driving Status interaction with objective physical activity or reported transport walking. For leisure walking, almost all environmental attributes were positive and significant among driving older adults but not among nondriving older adults (five significant interactions at p < .05). The findings suggest that driving status is likely to moderate the association between neighborhood environments and older adults' leisure walking.

Examining correlates of self-reported and objectively measured physical activity among retirement village residents

AIM

Physical activity (PA) patterns of retirement village residents were investigated using self-report and objective measures.

METHODS

Residents (n = 323) from retirement villages in Perth, Australia, were surveyed on PA behaviour and various demographic, residency, health-related and mobility factors. Most participants wore accelerometers for 7 days. Retirement village managers (n = 32) were surveyed on village descriptive characteristics, including the provision of amenities and facilities. Logistic regression models examined village and resident characteristics associated with PA.

RESULTS

Based on objective measurement, only 27.1% of participants were sufficiently active (n = 288). Walking was one of the most popular PA modes. Few village characteristics were associated with PA; however, villages located in more walkable neighbourhoods increased participants' odds of transport walking. Travelling outside the village daily also increased PA odds.

CONCLUSIONS

Most residents were insufficiently active to gain health benefits. Considering individual and environmental factors, within the retirement village and neighbourhood settings, and associations with PA, warrants attention.

Association between out-of-home trips and older adults' functional fitness

AIM

To explore the purposes of older adults' out-of-home trips, and to investigate the association between the frequency of these trips and older adults' functional fitness.

METHODS

A total of 412 older adults in Taiwan were recruited from 2009 to 2010. Participants were asked to fill out questionnaires on out-of-home trips, and trained volunteers assessed the functional fitness of respondents using objective measures. Descriptive statistics, univariate analysis, multivariate regression analysis and canonical correlation analysis were then used to analyze the resulting data.

RESULTS

Results show that exercise is most frequently the purpose for going out at least once a day, and that parks are the most preferred places to visit. Sex and age are the significant variables explaining variance in older adults' flexibility and physical power, respectively. Canonical correlation analysis showed one significant variate pair (R(2)(c)  = 8.80) between the frequency of out-of-home trips (engaging in exercise and participating in religious activities) and fitness measure test scores including the chair stand, arm curl, 2-min step, and 8-foot up-and-go. The relationship did not exist for the back scratch, nor chair sit-and-reach test scores.

CONCLUSION

The present study provides empirical and objective evidence on older adults' purposes for taking out-of-home trips, and for the positive association between the frequency of these trips, and the muscular strength and cardiovascular endurance, but not flexibility, of older adults.

Older adults' transportation walking: a cross-sectional study on the cumulative influence of physical environmental factors

Background

The physical environment may play a crucial role in promoting older adults’ walking for transportation. However, previous studies on relationships between the physical environment and older adults’ physical activity behaviors have reported inconsistent findings. A possible explanation for these inconsistencies is the focus upon studying environmental factors separately rather than simultaneously. The current study aimed to investigate the cumulative influence of perceived favorable environmental factors on older adults’ walking for transportation. Additionally, the moderating effect of perceived distance to destinations on this relationship was studied.

Methods

The sample was comprised of 50,685 non-institutionalized older adults residing in Flanders (Belgium). Cross-sectional data on demographics, environmental perceptions and frequency of walking for transportation were collected by self-administered questionnaires in the period 2004-2010. Perceived distance to destinations was categorized into short, medium, and large distance to destinations. An environmental index (=a sum of favorable environmental factors, ranging from 0 to 7) was constructed to investigate the cumulative influence of favorable environmental factors. Multilevel logistic regression analyses were applied to predict probabilities of daily walking for transportation.

Results

For short distance to destinations, probability of daily walking for transportation was significantly higher when seven compared to three, four or five favorable environmental factors were present. For medium distance to destinations, probabilities significantly increased for an increase from zero to four favorable environmental factors. For large distance to destinations, no relationship between the environmental index and walking for transportation was observed.

Conclusions

Our findings suggest that the presence of multiple favorable environmental factors can motivate older adults to walk medium distances to facilities. Future research should focus upon the relationship between older adults’ physical activity and multiple environmental factors simultaneously instead of separately.

Walking for transportation in Hong Kong Chinese urban elders: a cross-sectional study on what destinations matter and when

Background

Walking for transport can contribute to the accrual of health-enhancing levels of physical activity in elders. Identifying destinations and environmental conditions that facilitate this type of walking has public health significance. However, most findings are limited to Western, low-density locations, while a larger proportion of the global population resides in ultra-dense Asian metropolises. We investigated relationships of within-neighborhood objectively-measured destination categories and environmental attributes with walking for transport in 484 elders from an ultra-dense metropolis (Hong Kong).

Methods

We estimated relationships of diversity (number of different types) and prevalence of within-neighborhood destination categories (environmental audits of 400 m buffers surrounding residential addresses) with transport-related walking (interviewer–administered questionnaire) in 484 Chinese-speaking elders able to walk unassisted and living in 32 neighborhoods stratified by socio-economic status and transport-related walkability. We examined the moderating effects of safety and pedestrian infrastructure-related neighborhood attributes on destination-walking associations.

Results

Participants reported on average 569 and 254 min/week of overall and within-neighborhood walking for transport, respectively. The prevalence of public transit points and diversity of recreational destinations were positively related to overall walking for transport. The presence of a health clinic/service and place of worship, higher diversity in recreational destinations, and greater prevalence of non-food retails and services, food/grocery stores, and restaurants in the neighborhood were predictive of more within-neighborhood walking for transport. Neighborhood safety-related aspects moderated the relationship of overall walking for transport with the prevalence of public transit points, this being positive only in safe locations. Similar moderating effects of safety-related attributes were observed for the relationships of within-neighborhood walking for transport with diversity of recreational and entertainment destinations. Pedestrian-infrastructure attributes acted as moderators of associations of within-neighborhood walking for transport with prevalence of commercial destination categories. Composite destinations indices consisting of destination categories related to the specific measures of walking were positively associated with walking for transport.

Conclusions

The availability of both non-commercial and commercial destinations may promote within-neighborhood walking for transport, while recreational facilities and public transit points may facilitate overall walking for transport. However, destination-rich areas need to also provide adequate levels of personal safety and a physically-unchallenging pedestrian network.

Development, scoring, and reliability of the Microscale Audit of Pedestrian Streetscapes (MAPS)

BACKGROUND

Streetscape (microscale) features of the built environment can influence people's perceptions of their neighborhoods' suitability for physical activity. Many microscale audit tools have been developed, but few have published systematic scoring methods. We present the development, scoring, and reliability of the Microscale Audit of Pedestrian Streetscapes (MAPS) tool and its theoretically-based subscales.

METHODS

MAPS was based on prior instruments and was developed to assess details of streetscapes considered relevant for physical activity. MAPS sections (route, segments, crossings, and cul-de-sacs) were scored by two independent raters for reliability analyses. There were 290 route pairs, 516 segment pairs, 319 crossing pairs, and 53 cul-de-sac pairs in the reliability sample. Individual inter-rater item reliability analyses were computed using Kappa, intra-class correlation coefficient (ICC), and percent agreement. A conceptual framework for subscale creation was developed using theory, expert consensus, and policy relevance. Items were grouped into subscales, and subscales were analyzed for inter-rater reliability at tiered levels of aggregation.

RESULTS

There were 160 items included in the subscales (out of 201 items total). Of those included in the subscales, 80 items (50.0%) had good/excellent reliability, 41 items (25.6%) had moderate reliability, and 18 items (11.3%) had low reliability, with limited variability in the remaining 21 items (13.1%). Seventeen of the 20 route section subscales, valence (positive/negative) scores, and overall scores (85.0%) demonstrated good/excellent reliability and 3 demonstrated moderate reliability. Of the 16 segment subscales, valence scores, and overall scores, 12 (75.0%) demonstrated good/excellent reliability, three demonstrated moderate reliability, and one demonstrated poor reliability. Of the 8 crossing subscales, valence scores, and overall scores, 6 (75.0%) demonstrated good/excellent reliability, and 2 demonstrated moderate reliability. The cul-de-sac subscale demonstrated good/excellent reliability.

CONCLUSIONS

MAPS items and subscales predominantly demonstrated moderate to excellent reliability. The subscales and scoring system represent a theoretically based framework for using these complex microscale data and may be applicable to other similar instruments.

Association between physical activity and neighborhood environment among middle-aged adults in Shanghai

Objective. To determine the perceived neighborhood environment (NE) variables that are associated with physical activity (PA) in urban areas in China. Methods. Parents of students at two junior high schools in Shanghai, one downtown and the other in the suburbs, were recruited to participate in the study. They completed an International Physical Activity Questionnaire (IPAQ) and Neighborhood Environment Walkability Scale-Abbreviated (NEWS-A) survey. Participant physical activity was also objectively measured using accelerometers. Results. Participants from downtown areas were more positively associated with transportation PA and leisure-time PA than respondents living in the suburbs. Residential density was found to be a significant positive predictor of recreational or leisure-based PA. Street connectivity was negatively associated with leisure time PA for respondents. Moderate-vigorous PA was found to be negatively associated with traffic safety. There were no significant associations between environmental factors and transportation PA. Women had higher levels of moderate-vigorous PA than men. Conclusions. The results of this study demonstrate that residential density, street connectivity, and traffic safety have a significant impact on Chinese middle-aged adults' PA, suggesting urban planning strategies for promoting positive public health outcomes.

Determinants of neighborhood activity of adults age 70 and over: a mixed-methods study

BACKGROUND

This mixed-methods study investigated personal, interpersonal, and environmental factors salient to decisions about being active in neighborhoods of different levels of deprivation.

METHODS

Twenty-five participants age 70 years and older (10 women) with diverse physical activity levels provided data on their weekly activity patterns (using accelerometry) and their perceived barriers to exercise (questionnaire). They also participated in semistructured individual interviews exploring the barriers and facilitators influencing neighborhood activity.

RESULTS

Functional limitations, lack of intrinsic motivation, and not having an activity companion were the highest impact barriers. Walkable access to amenities, positive physical activity perceptions, and existing habit of being active were the highest impact facilitators.

CONCLUSIONS

The perceived quality and accessibility of the built and natural environments influence neighborhood activity in older adults. However, this relationship might be altered through the influence of personal and interpersonal determinants such as maintenance of good health and functional ability and supportive social networks.

Walking for recreation and perceptions of the neighborhood environment in older Chinese urban dwellers

Engagement in walking for recreation can contribute to healthy aging. Although there is growing evidence that the neighborhood environment can influence walking for recreation, the amount of such evidence in relation to older adults is scarce and limited to Western low-density urban locations. Asian urban environments are typified by distinctive environmental and cultural characteristics that may yield different patterns to those observed in Western countries. Therefore, the main aim of this study was to examine associations of perceived environmental attributes with overall and within-neighborhood walking for recreation in Chinese elders (65+ years) residing in Hong Kong, an ultradense Asian metropolis. A sample of 484 elders was recruited from 32 neighborhoods stratified by socio-economic status and walkability (dwelling and intersection densities). Validated questionnaires measuring perceived neighborhood environment and weekly minutes of overall and within-neighborhood walking for recreation were interviewer administered. Results showed that the level of recreational walking was twice to four times higher than that reported in Western adults and elders. While overall walking for recreation showed a general lack of associations with perceived environmental attributes, within-neighborhood recreational walking was positively related with proximity of recreational facilities, infrastructure for walking, indoor places for walking, and presence of bridge/overpasses connecting to services. Age and educational attainment moderated the associations with several perceived environmental attributes with older and less-educated participants showing stronger associations. Traditional cultural views on the benefits of physical activity and the high accessibility of facilities and pedestrian infrastructure of Hong Kong may explain the high levels of walking. Although specific neighborhood attributes, or their perception, may influence recreational walking within the neighborhood, the compactness and public transport affordability of ultradense metropolises such as Hong Kong may make it easy for elders to compensate for the lack of favorable neighborhood attributes by walking outside the neighborhood.

Objectively-measured neighborhood environments and leisure-time physical activity in Chinese urban elders

OBJECTIVE

The built environment may impact on elders' ability to engage in leisure-time physical activity (LTPA). Environmental correlates of LTPA in older Chinese residents of ultra-dense cities are unknown. The main aim of this study was to identify the aspects of the neighborhood environment associated with LTPA of Chinese elders residing in an ultra-dense city and able to walk unassisted.

METHODS

This study was conducted in Hong Kong in 2007-2008. We investigated the relationships of neighborhood environmental attributes (environmental audits) with LTPA (interviewer-administered questionnaire) in 484 elders able to walk unassisted and living in 32 neighborhoods stratified by socio-economic status and walkability.

RESULTS

The amount of recreational walking was positively related to the availability of parks (e(b) = 1.03; 95% CI = 1.02, 1.05) and several other environmental attributes. The odds of non-participation in other LTPA (OLTPA) were related to availability of recreational facilities (ORs from 0.96 to 0.99) and infrastructure, aesthetics, and safety aspects of the neighborhood. These aspects also moderated the relationships of recreational facilities with non-participation in OLTPA, being negative only in safe, aesthetically-pleasing locations with good infrastructure.

CONCLUSIONS

Safe, aesthetically-pleasing, low-pollution neighborhoods with easy access to recreational and public facilities may facilitate the engagement in LTPA in Chinese urban elders able to walk unassisted.

Do changes to the local street environment alter behaviour and quality of life of older adults? The 'DIY Streets' intervention

Background

The burden of ill-health due to inactivity has recently been highlighted. Better studies on environments that support physical activity are called for, including longitudinal studies of environmental interventions. A programme of residential street improvements in the UK (Sustrans ‘DIY Streets’) allowed a rare opportunity for a prospective, longitudinal study of the effect of such changes on older adults’ activities, health and quality of life.

Methods

Pre–post, cross-sectional surveys were carried out in locations across England, Wales and Scotland; participants were aged 65+ living in intervention or comparison streets. A questionnaire covered health and quality of life, frequency of outdoor trips, time outdoors in different activities and a 38-item scale on neighbourhood open space. A cohort study explored changes in self-report activity and well-being postintervention. Activity levels were also measured by accelerometer and accompanying diary records.

Results

The cross-sectional surveys showed outdoor activity predicted by having a clean, nuisance-free local park, attractive, barrier-free routes to it and other natural environments nearby. Being able to park one's car outside the house also predicted time outdoors. The environmental changes had an impact on perceptions of street walkability and safety at night, but not on overall activity levels, health or quality of life. Participants’ moderate-to-vigorous activity levels rarely met UK health recommendations.

Conclusions

Our study contributes to methodology in a longitudinal, pre–post design and points to factors in the built environment that support active ageing. We include an example of knowledge exchange guidance on age-friendly built environments for policy-makers and planners.

Neighborhood environment profiles for physical activity among older adults

OBJECTIVES

To explore among older adults whether multivariate neighborhood profiles were associated with physical activity (PA) and BMI.

METHODS

Adults (66-97 years) were recruited from Baltimore-Washington, DC (n=360), and Seattle-King County, Washington (n=368), regions. Latent profile analyses were conducted using the Neighborhood Environment Walkability Scale. ANCOVA models tested for criterion validity of profiles by examining relationships to PA and BMI.

RESULTS

Neighborhood profiles differed significantly by as much as 10 minutes/day for moderate-to-vigorous PA, 1.1 hours/week for walking for errands, and almost 50 minutes/week for leisure PA.

CONCLUSIONS

Environmental variables resulted in meaningful neighborhood patterns that explained large differences in seniors' health outcomes.

Applying the ecological model of behavior change to a physical activity trial in retirement communities: description of the study protocol

OBJECTIVES

To describe the intervention protocol for the first multilevel ecological intervention for physical activity in retirement communities that addresses individual, interpersonal and community influences on behavior change.

DESIGN

A cluster randomized controlled trial design was employed with two study arms: a physical activity intervention and an attention control successful aging condition.

SETTING

Sixteen continuing care retirement communities in San Diego County.

PARTICIPANTS

Three hundred twenty older adults, aged 65 years and older, are being recruited to participate in the trial. In addition, peer leaders are being recruited to lead some study activities, especially to sustain the intervention after study activities ceased.

INTERVENTION

Participants in the physical activity trial receive individual, interpersonal and community intervention components. The individual level components include pedometers, goal setting and individual phone counseling. The interpersonal level components include group education sessions and peer-led activities. The community level components include resource audits and enumeration, tailored walking maps, and community improvement projects. The successful aging group receives individual and group attention about successful aging topics.

MEASUREMENTS

The main outcome is light to moderate physical activity, measured objectively by accelerometry. Other objective outcomes included physical functioning, blood pressure, physical fitness, and cognitive functioning. Self report measures include depressive symptoms and health related quality of life.

RESULTS

The intervention is being delivered successfully in the communities and compliance rates are high.

CONCLUSION

Ecological Models call for interventions that address multiple levels of the model. Previous studies have not included components at each level and retirement communities provide a model environment to demonstrate how to implement such an intervention.

Environmental Factors Associated With Active Living in Retirement Village Residents

This exploratory enquiry employs qualitative methods to advance knowledge and understanding of physical environmental attributes related to active living among residents of Australian retirement villages. Six focus groups ( n = 51 residents) were held and participants described how their current, and subsequently ideal, retirement village and neighborhood supported active lifestyles. Thematic analysis revealed three key environmental factors associated with active living: a positive social environment within the village; services and facilities provided in the village and wider neighborhood; and the presence of suitable pedestrian infrastructure. The unique discovery that environmental factors of both the retirement village and the surrounding neighborhood were associated with residents’ active living raises many questions for study. Findings informed the development of a survey instrument, and further understanding in this area has the potential to contribute to the design and siting practices of senior housing complexes within neighborhoods.

Associations of physical activity with neighborhood environments and transportation modes in older Japanese adults

OBJECTIVE

We investigated associations of walking and other leisure-time physical activity (LTPA) with environmental characteristics and transportation modes in older Japanese adults.

METHODS

This cross-sectional study in 2010-2011 used data from 421 community-dwelling older adults aged 65-85 years living in Kasama City, rural Japan. We used the Physical Activity Scale for the Elderly to assess walking and other LTPAs, and the International Physical Activity Questionnaire Environment Module for neighborhood environments.

RESULTS

After adjusting for confounders, we found that good traffic safety and aesthetics were positively associated with high levels of walking (ORs=1.64-2.12); whereas, good access to public transportation was negatively associated with walking (OR=0.64, 95% CI=0.42-0.98). Good access to recreational facilities, presence of sidewalks, absence of hills, seeing people exercise, and aesthetically pleasing surroundings were positively associated with high levels of LTPA except walking (ORs=1.61-2.13). Individuals who rode bicycles more than once per week were more likely to engage in a LTPA except walking (1-3 days: OR=1.72, 95% CI=1.03-2.87; ≥4 days: OR=2.90, 95% CI=1.71-4.93).

CONCLUSION

This study adds information on correlates of physical activity among older Japanese adults; the positive association between LTPA except walking and the frequency of bicycle travel is an especially new and intriguing finding.

Correlates of physical activity: why are some people physically active and others not?

Physical inactivity is an important contributor to non-communicable diseases in countries of high income, and increasingly so in those of low and middle income. Understanding why people are physically active or inactive contributes to evidence-based planning of public health interventions, because effective programmes will target factors known to cause inactivity. Research into correlates (factors associated with activity) or determinants (those with a causal relationship) has burgeoned in the past two decades, but has mostly focused on individual-level factors in high-income countries. It has shown that age, sex, health status, self-efficacy, and motivation are associated with physical activity. Ecological models take a broad view of health behaviour causation, with the social and physical environment included as contributors to physical inactivity, particularly those outside the health sector, such as urban planning, transportation systems, and parks and trails. New areas of determinants research have identified genetic factors contributing to the propensity to be physically active, and evolutionary factors and obesity that might predispose to inactivity, and have explored the longitudinal tracking of physical activity throughout life. An understanding of correlates and determinants, especially in countries of low and middle income, could reduce the eff ect of future epidemics of inactivity and contribute to effective global prevention of non-communicable diseases.

Environmental factors influencing older adults' walking for transportation: a study using walk-along interviews

Background

Current knowledge on the relationship between the physical environment and walking for transportation among older adults (≥ 65 years) is limited. Qualitative research can provide valuable information and inform further research. However, qualitative studies are scarce and fail to include neighborhood outings necessary to study participants’ experiences and perceptions while interacting with and interpreting the local social and physical environment. The current study sought to uncover the perceived environmental influences on Flemish older adults’ walking for transportation. To get detailed and context-sensitive environmental information, it used walk-along interviews.

Methods

Purposeful convenience sampling was used to recruit 57 older adults residing in urban or semi-urban areas. Walk-along interviews to and from a destination (e.g. a shop) located within a 15 minutes’ walk from the participants’ home were conducted. Content analysis was performed using NVivo 9 software (QSR International). An inductive approach was used to derive categories and subcategories from the data.

Results

Data were categorized in the following categories and subcategories: access to facilities (shops & services, public transit, connectivity), walking facilities (sidewalk quality, crossings, legibility, benches), traffic safety (busy traffic, behavior of other road users), familiarity, safety from crime (physical factors, other persons), social contacts, aesthetics (buildings, natural elements, noise & smell, openness, decay) and weather.

Conclusions

The findings indicate that to promote walking for transportation a neighborhood should provide good access to shops and services, well-maintained walking facilities, aesthetically appealing places, streets with little traffic and places for social interaction. In addition, the neighborhood environment should evoke feelings of familiarity and safety from crime. Future quantitative studies should investigate if (changes in) these environmental factors relate to (changes in) older adults’ walking for transportation.

Using GPS technology to (re)-examine operational definitions of 'neighbourhood' in place-based health research

BACKGROUND

Inconsistencies in research findings on the impact of the built environment on walking across the life course may be methodologically driven. Commonly used methods to define 'neighbourhood', from which built environment variables are measured, may not accurately represent the spatial extent to which the behaviour in question occurs. This paper aims to provide new methods for spatially defining 'neighbourhood' based on how people use their surrounding environment.

RESULTS

Informed by Global Positioning Systems (GPS) tracking data, several alternative neighbourhood delineation techniques were examined (i.e., variable width, convex hull and standard deviation buffers). Compared with traditionally used buffers (i.e., circular and polygon network), differences were found in built environment characteristics within the newly created 'neighbourhoods'. Model fit statistics indicated that exposure measures derived from alternative buffering techniques provided a better fit when examining the relationship between land-use and walking for transport or leisure.

CONCLUSIONS

This research identifies how changes in the spatial extent from which built environment measures are derived may influence walking behaviour. Buffer size and orientation influences the relationship between built environment measures and walking for leisure in older adults. The use of GPS data proved suitable for re-examining operational definitions of neighbourhood.

Identifying built environmental patterns using cluster analysis and GIS: relationships with walking, cycling and body mass index in French adults

Background

Socio-ecological models suggest that both individual and neighborhood characteristics contribute to facilitating health-enhancing behaviors such as physical activity. Few European studies have explored relationships between local built environmental characteristics, recreational walking and cycling and weight status in adults. The aim of this study was to identify built environmental patterns in a French urban context and to assess associations with recreational walking and cycling behaviors as performed by middle-aged adult residents.

Methods

We used a two-step procedure based on cluster analysis to identify built environmental patterns in the region surrounding Paris, France, using measures derived from Geographic Information Systems databases on green spaces, proximity facilities (destinations) and cycle paths. Individual data were obtained from participants in the SU.VI.MAX cohort; 1,309 participants residing in the Ile-de-France in 2007 were included in this analysis. Associations between built environment patterns, leisure walking/cycling data (h/week) and measured weight status were assessed using multinomial logistic regression with adjustment for individual and neighborhood characteristics.

Results

Based on accessibility to green spaces, proximity facilities and availability of cycle paths, seven built environmental patterns were identified. The geographic distribution of built environmental patterns in the Ile-de-France showed that a pattern characterized by poor spatial accessibility to green spaces and proximity facilities and an absence of cycle paths was found only in neighborhoods in the outer suburbs, whereas patterns characterized by better spatial accessibility to green spaces, proximity facilities and cycle paths were more evenly distributed across the region. Compared to the reference pattern (poor accessibility to green areas and facilities, absence of cycle paths), subjects residing in neighborhoods characterized by high accessibility to green areas and local facilities and by a high density of cycle paths were more likely to walk/cycle, after adjustment for individual and neighborhood sociodemographic characteristics (OR = 2.5 95%CI 1.4-4.6). Body mass index did not differ across patterns.

Conclusions

Built environmental patterns were associated with walking and cycling among French adults. These analyses may be useful in determining urban and public health policies aimed at promoting a healthy lifestyle.

Measured and perceived environmental characteristics are related to accelerometer defined physical activity in older adults

BACKGROUND

Few studies have investigated both the self-perceived and measured environment with objectively determined physical activity in older adults. Accordingly, the aim of this study was to examine measured and perceived environmental associations with physical activity of older adults residing across different neighborhood types.

METHODS

One-hundred and forty-eight older individuals, mean age 64.3 ± 8.4, were randomly recruited from one of four neighborhoods that were pre-determined as either having high- or low walkable characteristics. Individual residences were geocoded and 200 m network buffers established. Both objective environment audit, and self-perceived environmental measures were collected, in conjunction with accelerometer derived physical activity behavior. Using both perceived and objective environment data, analysis consisted of a macro-level comparison of physical activity levels across neighborhood, and a micro-level analysis of individual environmental predictors of physical activity levels.

RESULTS

Individuals residing in high-walkable neighborhoods on average engaged in 11 min of moderate to vigorous physical activity per day more than individuals residing in low-walkable neighborhoods. Both measured access to non-residential destinations (b = .11, p < .001) and self-perceived access to non-residential uses (b = 2.89, p = .031) were significant predictors of time spent in moderate to vigorous physical activity. Other environmental variables significantly predicting components of physical activity behavior included presence of measured neighborhood crime signage (b = .4785, p = .031), measured street safety (b = 26.8, p = .006), and perceived neighborhood satisfaction (b = .5.8, p = .003).

CONCLUSIONS

Older adult residents who live in high-walkable neighborhoods, who have easy and close access to nonresidential destinations, have lower social dysfunction pertinent to crime, and generally perceive the neighborhood to a higher overall satisfaction are likely to engage in higher levels of physical activity behavior. Efforts aimed at promoting more walkable neighborhoods could influence activity levels in older adults.

Physical environmental factors related to walking and cycling in older adults: the Belgian aging studies

BACKGROUND

Socio-ecological models emphasize the relationship between the physical environment and physical activity (PA). However, knowledge about this relationship in older adults is limited. Therefore, the present study aims to investigate the relationship between area of residence (urban, semi-urban or rural) and older adults' walking and cycling for transportation and recreation. Additionally, relationships between several physical environmental factors and walking and cycling and possible moderating effects of area of residence, age and gender were studied.

METHODS

Data from 48,879 Flemish older adults collected in 2004-2010 through peer research were analyzed. Walking, cycling and environmental perceptions were assessed using self-administered questionnaires. The Study Service of the Flemish Government provided objective data on municipal characteristics. Multilevel logistic regression analyses were applied.

RESULTS

Urban participants were more likely to walk daily for transportation compared to rural (OR = 1.43; 95% CI = 1.22, 1.67) and semi-urban participants (OR = 1.32; 95% CI = 1.13, 1.54). Urban participants were less likely to cycle daily for transportation compared to semi-urban participants (OR = 0.72; 95% CI = 0.56, 0.92). Area of residence was unrelated to weekly recreational walking/cycling. Perceived short distances to services (ORs ranging from 1.04 to 1.19) and satisfaction with public transport (ORs ranging from 1.07 to 1.13) were significantly positively related to all walking/cycling behaviors. Feelings of unsafety was negatively related to walking for transportation (OR = 0.93, 95% CI = 0.91, 0.95) and recreational walking/cycling (OR = 0.95, 95% CI = 0.92, 0.97). In females, it was also negatively related to cycling for transportation (OR = 0.94, 95% CI = 0.90, 0.98).

CONCLUSIONS

Urban residents were more likely to walk for transportation daily compared to semi-urban and rural residents. Daily cycling for transportation was less prevalent among urban compared to semi-urban residents. Access to destinations appeared to be important for promoting both walking and cycling for transportation and recreation across all demographic subgroups. Additionaly, feelings of unsafety were associated with lower rates of walking for transportation and walking/cycling for recreation in all subgroups and cycling for transportation in females. No clear patterns emerged for other environmental factors.

Neighborhood Influences on Participation among Older Adults with Chronic Health Conditions: A Scoping Review

Older adults with chronic health conditions face difficulties participating in everyday occupations but may gain support to do so from neighborhood environments. This article describes research regarding neighborhood influences on participation in this population. A scoping review identified 689 articles, of which 15 met the selection criteria. Findings indicate that neighborhood economic status, services/resources, mobility resources/barriers, physical problems, cohesion, and safety are linked to participation in older adults and older adults with chronic conditions. Most studies measured participation frequency or limitations and did not consider social support as a covariate. These findings can guide research to examine a range of neighborhood characteristics while considering the effects of the individual's characteristics and social support. Longitudinal and qualitative research can also help to understand this complex area of study.

Interactions between psychosocial and built environment factors in explaining older adults' physical activity

OBJECTIVE

To evaluate ecological model predictions of cross-level interactions among psychosocial and environmental correlates of physical activity in 719 community-dwelling older adults in the Baltimore, Maryland and Seattle, Washington areas during 2005-2008.

METHOD

Walkability, access to parks and recreation facilities and moderate-to-vigorous physical activity (MVPA) minutes per week (min/week) were measured objectively. Neighborhood aesthetics, walking facilities, social support, self-efficacy, barriers and transportation and leisure walking min/week were self-reported.

RESULTS

Walkability interacted with social support in explaining total MVPA (B=13.71) and with social support (B=7.90), self-efficacy (B=7.66) and barriers (B=-8.26) in explaining walking for transportation. Aesthetics interacted with barriers in explaining total MVPA (B=-12.20) and walking facilities interacted with self-efficacy in explaining walking for leisure (B=-10.88; Ps<.05). Summarizing across the interactions, living in a supportive environment (vs. unsupportive) was related to 30-59 more min/week of physical activity for participants with more positive psychosocial attributes, but only 0-28 more min/week for participants with less positive psychosocial attributes.

CONCLUSION

Results supported synergistic interactions between built environment and psychosocial factors in explaining physical activity among older adults. Findings suggest multilevel interventions may be most effective in increasing physical activity.

Built environment, physical activity, and obesity: what have we learned from reviewing the literature?

To evaluate the growing literature on the built environment and physical activity/obesity, we conducted a review of review papers. Through a systematic search, we identified 36 reviews that met the inclusion criteria and evaluated these reviews based on key information provided, review methodology, and specificity regarding measurement. We also analyzed research gaps and areas of improvement identified by previous reviews and propose a research agenda. Future studies should develop complex conceptual and statistical models that include moderators and mediators, improve objective and perceived measures of the built environment, and strengthen evidence of causality through better research designs.

Neighborhood built environment and physical activity of Japanese older adults: results from the Aichi Gerontological Evaluation Study (AGES)

BACKGROUND

Although many studies have reported the association between neighborhood built environment (BE) and physical activity (PA), less is known about the associations for older populations or in countries besides the US and Australia. The aim of this paper is to examine the associations for older adult populations in Japan.

METHODS

Our analyses were based on cross-sectional data from the Aichi Gerontological Evaluation Study (AGES), conducted in 2003. The respondents were older adults, aged 65 years or over (n = 9,414), from 8 municipalities across urban, suburban, and rural areas. The frequency of leisure time sports activity and total walking time were used as the outcome variables. Using geographic information systems (GIS), we measured residential density, street connectivity, number of local destinations, access to recreational spaces, and land slope of the respondents' neighborhoods, based on network distances with multiple radii (250 m, 500 m, 1,000 m). An ordinal logistic regression model was used to analyze the association between PA and BE measures.

RESULTS

Population density and presence of parks or green spaces had positive associations with the frequency of sports activity, regardless of the selected buffer zone. The analysis of total walking time, however, showed only a few associations.

CONCLUSIONS

Our findings provide mixed support for the association between PA and the characteristics of BE measures, previously used in Western settings. Some characteristics of the neighborhood built environment may facilitate leisure time sports activity, but not increase the total walking time for Japanese older adults.