Park availability and physical activity, TV time, and overweight and obesity among women: Findings from Australia and the United States

Park proximity and all-day and time-specific physical activity and sedentary behaviour in older adults

BACKGROUND

Proximity to parks has been suggested as a factor influencing physical activity in older adults. However, it remains unclear the optimal distance between residences and parks for promoting physical activity and reducing sedentary time and whether these associations vary by the time of day. We examined whether the proximity to neighbourhood parks at varying distances is associated with all-day and time-specific physical activity and sedentary behaviour in older adults.

METHODS

Data were collected from 214 older adults receiving hospital services in Taipei, Taiwan. The number of parks within 400m, 800m, and 1,600m of participants' residences. Physical activity and sedentary behaviour, stratified by time of day (morning, afternoon, and evening), were measured using accelerometers. Adjusted linear regression models were used to estimate associations of park proximity with activity and sedentary outcomes.

RESULTS

Parks located within 400m and 800m of participants' residences were more markedly associated with longer time in physical activity and less sedentary time compared to parks located 1,600m away. A greater number of parks within 400m and 800m was positively associated with walking steps and light-intensity physical activity while both distances were negatively associated with sedentary time. The associations between park proximity and behavioural outcomes were mainly attributable to that during the afternoon and evening.

CONCLUSIONS

Our findings suggest that favourable access to parks within 800m of older adults' residences is associated with more physical activity and less sedentary time, particularly during the afternoon and evening. Future longitudinal studies are required to corroborate these associations.

Large-scale greenway exposure reduces sedentary behavior: A natural experiment in China

As a global public health problem, sedentary behavior has attracted more and more attention. Although numerous studies have demonstrated many benefits of green spaces to health, causal evidence on how green spaces affect people's sedentary behavior is scarce. This study used a natural experiment to evaluate the impact of greenway intervention on sedentary behavior. Two waves of data were collected in 2016 and 2019 (before and after the intervention) at East Lake Greenway (102-km-long) in Wuhan, China, with 1020 participants in 52 neighborhoods. We adopted three major methods to evaluate the impact of greenway intervention on sedentary behavior, including Propensity Score Matching and difference-in-difference (PSM-DID) method (with both individual and neighborhood variables to match samples), continuous treatment DID method (with distance to the greenway as the continuous treatment), and mediation analysis (with moderate to vigorous physical activity or MVPA, and walking time as the mediator). The results revealed that the greenway intervention significantly reduced participants' sedentary time and the intervention has a distance decay effect. The closer to the greenway, the greater decrease in sedentary time after the greenway opening. Furthermore, we found that MVPA and walking time mediate the impact of the greenway intervention on the change in sedentary behavior. The effect of greenway intervention was more beneficial for those under the age of 60, those who were employed, or those who were married. Our findings provided robust evidence that exposure to urban greenways affects sedentary behavior and such green infrastructures help protect public health in high-density urban areas.

Where and how to invest in greenspace for optimal health benefits: a systematic review of greenspace morphology and human health relationships

Research on the relationship between greenspace morphology and health is a growing field that informs the spatial design of greenspace to enhance health outcomes. This study reviews the current progress, methodologies, and knowledge gaps in this area. From a database search of 272 940 English articles and 39 053 Chinese articles up to April 18, 2024, we identified 22 and 7 studies on the topic for further evaluation. Predominantly cross-sectional and neighbourhood-scale analyses were conducted using land cover maps ranging from 0·25 to 100 meters in resolution. Six primary characteristics of greenspace morphology have been studied, including size, shape, fragmentation, connectedness, aggregation, and diversity. While associations between greenspace morphology and health outcomes have been observed, both their reliability and generalisability remain suggestive due to ecological study designs and heterogeneity among studies. Future research should prioritise individual-level prospective cohorts and intervention studies. Exploring mechanisms linking greenspace morphology and health, determining optimal map resolution, and distinguishing it from greenness magnitude in statistical analysis is essential. This evidence is crucial for health-promoting greenspace planning and should be routinely integrated into urban epidemiological research.

Association of greenspaces exposure with cardiometabolic risk factors: a systematic review and meta-analysis

BACKGROUND

Cardiometabolic conditions are major contributors to the global burden of disease. An emerging body of evidence has associated access to and surrounding public open spaces (POS) and greenspace with cardiometabolic risk factors, including obesity, body mass index (BMI), hypertension (HTN), blood glucose (BG), and lipid profiles. This systematic review aimed to synthesize this evidence.

METHODS

This systematic review was conducted based on the PRISMA guidelines. Four electronic databases including Web of Science, PubMed, Scopus, and Google Scholar were searched for eligible articles published until July 2023. All observational studies which assessed the association of greenspace and POS with cardiometabolic risk factors including obesity, BMI, HTN, BG, and lipid profiles were included and reviewed by two authors independently. Heterogeneity between studies was assessed using the I2 index and Cochrane's Q test. Random/fixed effect meta-analyses were used to combine the association between greenspace exposure with cardiometabolic risk factors.

RESULTS

Overall, 118 relevant articles were included in our review. The majority of the articles were conducted in North America or Europe. In qualitative synthesis, access or proximity to greenspaces or POS impacts BMI and blood pressure or HTN, BG, and lipid profiles via various mechanisms. According to the random effect meta-analysis, more access to greenspace was significantly associated with lower odds of HTN (odds ratio (OR): 0.81, 95% confidence intervals (CIs): 0.61-0.99), obesity (OR: 0.83, 95% CIs: 0.77-0.90), and diabetes (OR:0.79, 95% CI: 0.67,0.90).

CONCLUSIONS

Findings of this systematic review and meta-analysis suggested that greenspace accessibility is associated with some cardiometabolic risk factors. Improving greenspace accessibility could be considered as one of the main strategies to reduce cardiometabolic risk factors at population level.

Unraveling Visiting-Activity Patterns of Heterogeneous Communities for Urban-Park Planning and Design

Urban parks provide essential outdoor recreation space, especially for high-density cities. This study evaluated the park-visiting activity profiles of residents to inform the planning and design of community-relevant parks. The visiting and activity patterns of 465 Hong Kong adult residents were collected using a structured questionnaire. The correlations of visiting and activity patterns of the different socio-demographic groups were analyzed. Varying features of visiting and activity patterns were observed for different socio-demographic groups. Older patrons visited parks intensively for nature-enjoyment activities and had shorter travel if intended for social and physical-exercise activities. The middle-aged respondents with children mainly conducted family based recreation, visited parks more frequently, and traveled farther. The young adults reported lower patronage, but the visit frequency increased with the engagement level in outdoor and physical-exercise activities. The homemakers reported a high visit frequency and enthusiastic participation in social activities. They tended to visit more frequently and stay longer in parks for physical-exercise activities. Our study revealed the urban parks’ divergent patronage behavior and unique roles to disparate user groups. They furnished evidence to apply continually precision park planning, design, and promotion to achieve socially responsive and age-friendly parks.

Associations of public open space attributes with active and sedentary behaviors in dense urban areas: A systematic review of observational studies

In the context of rapid urbanization, public open spaces in dense urban areas are critical built environment elements to support active lifestyles. Several reviews have explored the associations of public open space attributes with physically active and sedentary behavior. However, few reviews have included studies from Asia, and no studies have focused on dense urban areas. This systematic review analyzed 18 observational studies investigating associations between public open space attributes with physical activity and sedentary behavior in dense urban areas of East Asian countries, including Japan, Taiwan, China, and Hong Kong. We found that closer distance to and a greater number of public open spaces and features within them were positively associated with leisure-time physical activity. Places near water features and corridors within public open spaces were associated with more sedentary behavior. These findings inform landscape and urban design guidelines for (re)designing public open spaces to support active lifestyles in high dense urban areas.

Trends in television viewing and overweight /obesity among Nepalese women: Findings from 2006, 2011 and 2016 Nepal Demographic and Health Surveys

BACKGROUND AND AIMS

Associations between overweight/obesity and television (TV) viewing have been identified in high-income countries, but little evidence is available from low- and middle-income countries. This study examined the trends and correlates of television viewing and overweight/obesity among Nepalese women between 2006 and 2016.

METHODS AND RESULTS

We analysed the data from 22,161 women aged 15-49 years who took part in Nepal Demographic Health Surveys 2006 (n = 10,115), 2011 (n = 5,881) or 2016 (n = 6,165). Trained staff collected data on TV viewing and sociodemographic attributes from a face-to-face survey while height and weight were measured objectively to determine body mass index. Around 38% of the study participants watched TV at least once a week in 2006, which increased to 49% in 2011 and 46% in 2016. The prevalence of overweight and obesity increased from 8% in 2006 to 14.6% in 2011 and 19.8% in 2016. Compared to those who did not watch TV at all, those watching it at least once a week were at 1.54 (95% CI: 1.02-2.33), 1.79 (95% CI: 1.23-2.60) and 1.46 (95% CI: 1.13-1.88) times higher odds of being overweight/obese in 2006, 2011 and 2016 respectively.

CONCLUSION

The prevalence of TV viewing rose among women in Nepal between 2006 and 2016 and was associated with overweight/obesity, which also increased dramatically over this period. Future studies examining the use of multiple screen devices, daily usage duration and content viewed are recommended to understand better the health impacts of transitions to more sedentary living in Nepal and similar settings.

Chronic disease and where you live: Built and natural environment relationships with physical activity, obesity, and diabetes

BACKGROUND

Diabetes is among the most prevalent non-communicable diseases causing significant morbidity and mortality globally. The aetiology and disease development of diabetes are influenced by genetic, lifestyle, and environmental factors. Due to an increasing number of cases each year, it is imperative to improve the understanding of modifiable environmental risk and protective factors. In this study we aimed to analyse associations between built and natural environment features and diabetes prevalence; and two major risk factors: physical activity and obesity and their mediation effects.

METHODS

We analysed relationships between walkability and park availability with physical activity, obesity, and diabetes, using self-reported data from a large cross-sectional survey in British Columbia, Canada (n = 22,418). We validated results with an independent cohort (n = 11,972) in a subset of the analyses. The outcome measures included walking, moderate to vigorous physical activity (MVPA), body mass index (BMI), and diabetes. Built and natural environment features within a 1 km road network buffer around residential postal code centroids were assessed using validated indicators of walkability and park availability. We used general linear multivariable models (GLM) to examine the direct relationship between environmental features, physical activity, obesity, and diabetes respectively. Path models were developed to analyse mediation effects of physical activity and obesity on the association between environmental indicators and diabetes. The relative contribution of direct versus indirect effects was assessed. All models were adjusted for age, gender, income. ethnicity, years lived in neighbourhood and regional accessibility.

RESULTS

Walkable neighbourhoods and areas with greater park availability were associated with lower rates of diabetes. There was a direct association of walkability and park availability on physical activity (highest vs. lowest quintile OR = 1.15; 95% CI: 1.00, 1.33 and OR = 1.28, 95% CI: 1.13, 1.45 respectively), obesity (highest vs. lowest quintile OR = 0.58, 95% CI: 0.49, 0.70 and OR = 0.57, 95% CI: 0.48, 0.68 respectively) and diabetes (highest vs. lowest quintile OR = 0.62, 95% CI: 0.45, 0.85, and OR = 0.63, 95% CI: 0.47, 0.84 respectively). Results were similar in the independent cohort. The associations between diabetes and walkability and park availability respectively were partly mediated by obesity (41% of total association for walkability and 53% of total association for park availability). The mediating effect of physical activity was negligible.

CONCLUSION

Results support investments in walkability through active transportation and transit infrastructure. Changes in zoning and subdivision regulations governing land use actions are required to enable compact mixed-use environments with access to parks and high quality transit service. Future studies including cost-benefit analyses of health-related economic impacts of such investments can contribute to evidence-based decisions for healthier cities.

Associations between cardiometabolic risks and physical activity in early adulthood: a cross-sectional study

OBJECTIVES

Young adults' physical activity (PA) is a foundation of creating future healthy lifestyles. The purpose of this study was to explore differences in PA, sedentary behaviour, walkability and health beliefs among young adults with different levels of cardiometabolic risks and the influence of moderate-to-vigorous PA.

DESIGN

A cross-sectional study was conducted using a structured questionnaire.

PARTICIPANTS

Totally, 1149 valid responses were received for a response rate of 86.32%. According to the self-reported worst health condition, participants were categorised into healthy adults, and adults at levels 1 (overweight), 2 (obese), 3 (hypertensive, hyperlipidaemic, and/or hyperglycaemic), and 4 (with a diagnosis of cardiometabolic diseases) of cardiometabolic risks.

PRIMARY OUTCOME MEASURES

PA, sedentary time, walkability and health beliefs.

RESULTS

Significant differences in PA (F=3.78, p<0.01) and sedentary time (F=2.39, p<0.05) among groups with various cardiometabolic risk levels were found. Healthy adults and adults at level 1 risk had significantly higher PA than adults at risk levels 2 and 3. Young adults at risk level 3 were less likely to participate in moderate-to-vigorous PA than were healthy adults (OR=0.64 (95% CI 0.41 to 0.99), p<0.05). Individuals who perceived that there were more recreational facilities (OR=1.27 (1.05 to 1.53), p<0.05), who had higher benefits of exercise (OR=1.73 (1.30 to 2.31), p<0.001), and who had lower barriers to exercise (OR=0.42 (0.32 to 0.55), p<0.001) were more likely to participate in moderate-to-vigorous PA.

CONCLUSIONS

Being aware of body weight changes could be a danger sign of a lack of PA. Developing environmental and psychological strategies to promote engaging in PA is necessary to promote the cardiometabolic health of young adults.

Community design and hypertension: Walkability and park access relationships with cardiovascular health

BACKGROUND

There is an increased literature focusing on the role of the built and natural environments in preventing hypertension. However, very few studies have quantitively analyzed specific pathways through which urban form affects blood pressure levels.

OBJECTIVES

To examine how features of the built and natural environments relate to hypertension and the mediating role of transportation and leisure walking and body mass index in this relationship.

METHODS

We examined the association between neighbourhood walkability and park availability with hypertension through generalized linear models in two independent population cohorts. One Cohort was 22,418 adults (My Health My Community) and the other cohort was 11,972 adults (BC Generations Project). We employed a path analysis modelling approach to explore the presence and significance of mediating factors that may contribute to any association between walkability or park availability and hypertension. This study intentionally employed walkability measures enforced through municipal zoning and subdivision regulations legally underpinned by health, safety, and welfare. All models were adjusted for socioeconomic and other characteristics where data were available.

RESULTS

Our analysis of two population-based Canadian cohorts consistently found that higher levels of walkability and park accessibility were both associated with significantly lower odds of self-reported hypertension, especially for lower income individuals. Mediation analysis showed that obesity accounted for 50% and 52.9% of the total effect of walkability and park accessibility on hypertension, respectively.

DISCUSSION

We suggest an integrated population health approach that considers multimorbidity as a result of exposure to car-dependent areas and the lack of green spaces. Longitudinal research is needed to document causal effects of built and natural environments on hypertension.

Dynamic Changes in Community Deprivation of Access to Urban Green Spaces by Multiple Transport Modes

Urban green spaces (UGSs) improve the quality of life of urban inhabitants. With the acceleration of urbanization and changes in traffic networks, it remains unclear whether changes in the distribution of UGSs can satisfy the needs of all inhabitants and offer equal services to inhabitants from different socioeconomic backgrounds. This study addresses this issue by analyzing dynamic changes in UGS accessibility in 2012, 2016, and 2020 for inhabitants of the central urban area of Fuzhou in China at the community level. The study introduces multiple transportation modes for an accessibility estimation based on a framework using the two-step floating catchment area method and examines the dynamic changes in community deprivation of UGS accessibility using Kernel regularized least squares, a machine learning algorithm. The results demonstrate that spatial disparities of UGS accessibility exist among the multi-transport modes and vary with time. Communities with high accessibility to UGSs by walking are scattered around the urban area; for accessibility by cycling, the high accessibility regions expand and surround the regions with low accessibility in the core urban areas, forming a semi-enclosed spatial pattern. However, the core urban spatial orientation of UGS accessibility by public transit demonstrates a reverse trend to the above two modes. The spatial pattern of UGS accessibility also varies over time, and the growth rate of accessibility slightly declined during the study period. Furthermore, the increase in UGS accessibility tended to slow from 2016–2020 compared with 2012–2016, and the trend toward equality was also erratic. The degree of deprivation for communities first weakened and was then aggravated, corresponding to the slowdown in the growth rate of accessibility, leading to the persistence existence of social inequality. Moreover, significant deprivation mainly exists among less educated people or those using the cycling and integrated travel modes. Although public transport is developing, deprived communities, such as communities with large proportion of older people, have experienced a decline in access to UGSs by public transport. Based on these findings, the study proposes a policy framework for the balanced distribution of UGSs as part of urbanization.

Gender Differences in Physical Activity Associated with Urban Neighborhood Parks: Findings from the National Study of Neighborhood Parks

INTRODUCTION

Urban neighborhood parks are designed to provide easy access to recreation and physical activity. We analyzed data from the first National Study of Neighborhood Parks, which assessed the characteristics and use of a representative sample of U.S. urban neighborhood parks. This article compares factors associated with active commuting (e.g., walking) to parks among men and women and park characteristics associated with observed moderate-to-vigorous physical activity (MVPA) within neighborhood parks.

METHODS

We used systematic direct observation to quantify parks visitors of all ages in 162 U.S. neighborhood parks in 25 cities in 2016 and surveyed a sample of adult visitors (877 women and 793 men). We used descriptive statistics to identify park facilities, amenities, and park management practices associated with park use. We also conducted multivariate regressions to identify factors most closely associated with observed park-based MVPA among all age groups and with self-reported levels of active commuting to parks among adults.

RESULTS

Reasons to visit parks varied by gender, with women more likely than men to bring children (59% vs 42% for men; p < .001), and men more likely than women to go to parks to relax (38% vs 29%; p = .01). Bringing children to parks was associated with more motorized transport among women, but not among men. Active commuting to parks was associated with living closer to parks (β = -0.92; p < .0001), a greater frequency of park use (β = 0.99; p < .0001), and the park having a working drinking fountain (β = 0.62; p = .01), with no significant differences between men and women. Men and boys used park facilities very differently than women and girls. Men and boys engaged in the most MVPA in soccer fields, gyms, and skate parks, whereas for women and girls the top three sites were pools, playgrounds, and walking paths.

CONCLUSIONS

Significant gender differences in why men and women visit parks and how parks are used likely reflect cultural determinants of gender roles. Our findings suggest that park management practices should be adjusted to mitigate the lower use of parks and lower levels of park-based MVPA among women and girls compared with men and boys.

Community participation of community dwelling older adults: a cross-sectional study

BACKGROUND

With the advancing age of the population, and increasing demands on healthcare services, community participation has become an important consideration for healthy ageing. Low levels of community participation have been linked to increased mortality and social isolation. The extent to which community participation has been measured objectively in older adults remains scarce. This study aims to describe where and how older adults participate in the community and determine the feasibility of measurement methods for community participation.

METHODS

This observational cross-sectional study obtained data from 46 community dwelling older adults. A combination of Global Positioning Systems (GPS), accelerometry, and self-reported diaries were used over a 7-day monitoring period. Feasibility of methods were determined by calculating the loss of GPS data, questionnaires, and comparison of self-reported locations with GPS co-ordinates. Relationships between community participation, physical activity, social interactions, health related quality of life, sleep quality and loneliness were explored.

RESULTS

Older adults took a median (IQR) of 15 (9.25-18.75) trips out of home over the 7-day monitoring period, most frequently visiting commercial and recreational locations. In-home activities were mainly sedentary in nature, with out of home activities dependent on location type. Self-reported and GPS measures of trips out of home and the locations visited were significantly correlated (self-report 15.7 (5.6) GPS 14.4 (5.8) (r = 0.94)). Significant correlations between both the number of trips taken from home, with social interactions (r = 0.62) and the minutes of moderate to vigorous physical activity (MVPA) (r = 0.43) were observed. Daily MVPA was higher in participants who visited local walk/greenspaces (r = 0.48).

CONCLUSION

Participants performed more activities with social interactions out of home and visited commercial locations most frequently. The combination of GPS, accelerometry and self-report methods provided a detailed picture of community participation for older adults. Further research is required with older adults of varying health status to generalise the relationships between community participation, location and physical activity.

TRIAL REGISTRATION

Ethical approval was gained from the Flinders University Social and Behavioural Research Ethics Committee (protocol no. 8176).

Neighborhood Urban Design and Outdoor Later Life: An Objective Assessment of Out-of-Home Time and Physical Activity Among Older Adults in Barcelona

This study explores how older adults' time out-of-home and physical activity (PA) are associated with the provision of urban open spaces (green spaces, plazas, and boulevards) and microelements (street trees and benches) in their neighborhoods. The authors used data from 103 residents in Barcelona and matched it to official geospatial data. The authors adjusted a set of mixed-effects linear regressions, both for the entire sample and also stratified by age and gender. For the entire sample, the percentage of green spaces showed a positive association with neighborhood time out-of-home and PA, while participants' PA also showed a positive association with the presence of benches. Outdoor time among older women was not associated with any of the measured exposures. For men, the provision of green spaces and benches was positively associated with time out-of-home and PA. These results could inform the design of urban spaces that aim to encourage outdoor activity among older adults.

Are park availability and satisfaction with neighbourhood parks associated with physical activity and time spent outdoors?

BACKGROUND

There is substantial scope for enhancing population health through increased park visits and active use of parks; however, a better understanding of factors that influence park visitation is needed. This cross-sectional study examined how parent-reported satisfaction and perceived availability of parks were associated with adults' physical activity and children's physical activity and time spent outdoors, and whether these associations were mediated by park visitation.

METHODS

Self-reported surveys were completed by adults living within 5 km of two parks located in Melbourne, Australia. Participants reported their satisfaction with neighbourhood park quality, walking duration from home to the nearest park, and park visitation in the past 7 days. Participants with a child aged 2-15 years also answered similar questions in relation to their child. The primary outcome variable for adults was leisure-time physical activity (LTPA) and for children was proxy-reported time spent outside. The secondary outcome for adults was combined transportation and LTPA and for children (5-15 years) was the number of days physical activity recommendations were met in the past 7 days.

RESULTS

Significant positive associations between park availability and park visitation in the past 7 days, and between park visitation and the outcome variables were observed among both adults (n = 1085, M_age = 48.9, SD 13.4) and children (n = 753, M_age = 8.8, SD = 3.7). The association between park satisfaction and park visitation was only significant among adults. Park visitation mediated associations between park availability and park satisfaction and the outcome variables among both adults and children.

CONCLUSIONS

Improving park availability and users' satisfaction with parks may increase visitation and consequently increase physical activity and time spent outdoors.

ParkIndex: Validation and application of a pragmatic measure of park access and use

Composite metrics integrating park availability, features, and quality for a given address or neighborhood are lacking. The purposes of this study were to describe the validation, application, and demonstration of ParkIndex in four diverse communities. This study occurred in Fall 2018 in 128 census block groups within Seattle(WA), Brooklyn(NY), Raleigh(NC), and Greenville County(SC). All parks within a half-mile buffer were audited to calculate a composite park quality score, and select households provided data about use of proximal parks via an online, map-based survey. For each household, the number of parks, total park acreage, and average park quality score within one half-mile were calculated using GIS. Logistic regression was used to identify a parsimonious model predicting park use. ParkIndex values (representing the probability of park use) were mapped for all study areas and after scenarios involving the addition and renovation/improvement of parks. Out of 360 participants, 23.3% reported visiting a park within the past 30 days. The number of parks (OR = 1.36, 95% CI = 1.15-1.62), total park acreage (OR = 1.13, 95% CI = 1.07-1.19), and average park quality score (OR = 1.04, 95% CI = 1.01-1.06) within one half-mile were all associated with park use. Composite ParkIndex values across the study areas ranged from 0 to 100. Hypothetical additions of or renovations to study area parks resulted in ParkIndex increases of 22.7% and 19.2%, respectively. ParkIndex has substantial value for park and urban planners, citizens, and researchers as a common metric to facilitate awareness, decision-making, and intervention planning related to park access, environmental justice, and community health.

Do the Walkability and Urban Leisure Amenities of Neighborhoods Affect the Body Mass Index of Individuals? Based on a Case Study in Seoul, South Korea

This study investigates the impact of neighborhood-built environments on obesity in interrelationship with socioeconomic status (SES)—controlling for dietary patterns and physical activities of residents—using structural equation modeling (SEM). A total of 577 samples who are between 19 and 64 years old and reside in Seoul are extracted from Korea National Health and Nutrition Examination Survey (KNHNES), 2015. Neighborhood environments are represented as the two latent constructs—walkability and leisure amenities—composited with indicators such as density of intersections, density of mixed-use area, and the area of open spaces and are aggregated by jurisdictional unit in Seoul. We found that greater walkability in a neighborhood explained a lower body mass index (BMI) among residents, whereas more urban leisure amenities in a neighborhood explained a higher BMI. The finding suggests that a walking-friendly environment is more effective than active recreational amenities in inducing people to engage in daily physical activities to the level that reduces obesity rate. SES exerted a negative impact on BMI of a greater magnitude than the impact of either of the environmental living conditions, reinforcing the importance of general wealth and education level in leading to a healthy lifestyle. Our research contributes to growing evidence of a relationship between obesity and the built environment in the context of Asian countries where the prevalence of obesity is becoming a serious issue and requires immediate attention.

Is the availability of open public spaces associated with leisure-time physical activity in Brazilian adults?

This study aims to analyse the association between perceived presence of public spaces near residences and practice of physical activity during leisure time by adults in the state capitals of Brazil, based on sociodemographic characteristics. Participants were individuals aged ≥18 years living in the 27 state capitals of Brazil (n = 52 929, 53.9% female) who responded to a national survey called VIGITEL in 2013. Physical activity during leisure time (≥1 time/week), perception of space, population and sociodemographic variables (sex, age, years of study and geographic region) were self-reported. The adjusted binary logistic regression analysis was used. Among adults, the prevalence of physical activity during leisure was 45.1% (95% CI [44.2; 46.0]), and 71.1% (95% CI [70.2, 71.8]) perceived public space near their residence. A direct association between perceiving public space and physical activity ([OR] = 1.43; 95% CI [1.32; 1.55]) was observed. No significant difference was observed in the population groups (men and women, younger and older adults, and those with more and fewer years of study). Thus, even with the possible regional differences in Brazilian state capitals, the presence of public spaces increases the practice of physical activity during leisure time, independent of sociodemographic variables.

Influence of Neighborhood Environment on Korean Adult Obesity Using a Bayesian Spatial Multilevel Model

Previous studies using spatial statistical modeling that account for spatial associations between geographic areas are scarce. Therefore, this study examines the association between neighborhood environment and obesity using a Bayesian spatial multilevel model. Data from 78,014 adults living in Gyeonggi province in Korea were drawn from the 2013–2014 Korean Community Health Survey. Korean government databases and ArcGIS software (version 10.1, ESRI, Redlands, CA) were used to measure the neighborhood environment for 546 administrative districts of Gyeonggi province. A Bayesian spatial multilevel model was implemented across gender and age groups. The findings indicate that women aged 19–39 years who lived in neighborhoods farthest away from parks were more likely to be obese. Men aged 40–59 years who lived in neighborhoods farther from public physical activity facilities and with lower population density were more likely to be obese. Obesity for women aged 19–39 years was the most spatially dependent, while obesity for women aged 40–59 years was the least spatially dependent. The results suggest that neighborhood environments that provide more opportunities for physical activity are negatively related to obesity. Therefore, the creation of physical activity in favorable neighborhood environments, considering gender and age, may be a valuable strategy to reduce obesity.

Determinants of physical activity: A path model based on an ecological model of active living

Maintaining physical activity is necessary to promote health in our daily lives. The Ecological Model of Active Living was proposed to examine whether individuals participate in active living. The purpose of this study was to understand the determinants of physical activity and create a predictive path model of the intrapersonal, perceived environment, behavior settings, and policy environment domains. Data were obtained from open government data and questionnaires, including the International Physical Activity Questionnaire, Health Belief Model Inventory, Physical Activity Neighborhood Environment Survey, and Accessibility of Open Spaces. Participants comprised 1085 healthy adults who completed a self-reported internet survey. An analysis of the intrapersonal domain revealed that the variables of female, an older age, and a low educational level, and individuals with obesity or cardiometabolic diseases presented lower odds ratios for active living. We found significant statistical support for our path model (The Ecological Model of Active Living), with a predictive power of 23.1%. The predictive path model is a good approach to quantitatively measure the impacts of various determinants on active living that suggests further lines of research in approaches for modeling relationships.

Impact of Low Caloric Diet and Exercise on Atherogenic Indices in Obese Hypertensive Adults

Background and aims: The influence of a low caloric diet with exercise were studied on several biochemical parameters including the lipid profile and atherogenic indices in overweight subjects including obesity with hypertension. Material and method: The study focused on 327 patients (144 men and 183 women) aged 54-73 years selected randomly, We chose hypertensives who live in the city of Tiaret and are over 50 years old, because it is the age group most affected by hypertension in Algeria and even in the world. We invited the subjects of our study to follow a program involving a low caloric diet, which was characterized by the suppression of the consumption of sucrose and refined white flour and by the choice of low-fat products, especially dairy products. Results: We observed a decrease in the mean value of blood pressure with its two components, systolic and diastolic. Systolic blood pressure ranged from 13.06 ± 1.40 cm Hg for the overall sample to 13.01 ± 1.12 cm Hg after the six-month program. The same finding is made for diastolic pressure, which decreased by 1.58% for the study population. For biochemical parameters, we observe a decrease in the mean value of all parameters after participation in the low-calorie diet and physical activity program, with the exception of HDL-c, which experienced an increase of 6.25%. Conclusions: The hypocaloric diet with exercise that we proposed to a group of hypertensives showed its effectiveness. A healthy lifestyle including a healthy and balanced diet with physical activity therefore allow better management of the hypertensive subject and could actually prevent atherosclerosis.

Urban residential greenness and adiposity: A cohort study in Stockholm County

BACKGROUND

Increasing evidence suggests that exposure to residential greenness is associated with positive health outcomes among urban populations. However, few studies have considered effects on adiposity development in a longitudinal setting.

OBJECTIVES

This study aimed to explore the association between long-term exposure to urban residential greenness and markers of adiposity.

METHODS

A cohort of 5126 adults from five municipalities in Stockholm County was examined clinically at baseline (1992-1998) and follow-up (2002-2006) after on average nine years. Time-weighted average exposure to urban greenness was estimated by Normalized Difference Vegetation Index (NDVI) within 100 m, 250 m, and 500 m buffers around the residential addresses of each participant. Multiple linear and Poisson regression models were used to estimate associations between greenness and change in weight and waist circumference as well as risk of overweight, obesity and central obesity. Co-exposures to air pollution, traffic noise and distance to water were also examined.

RESULTS

In women, higher levels of residential greenness were associated with a reduced increase in waist circumference during follow-up (β = -0.11 cm/year, 95% CI -0.14; -0.08 per one interquartile range increase in NDVI) and decreased risk for central obesity (IRR = 0.88: 95% CI 0.79; 0.99) in the 500 m buffer. No associations were observed for men or with regard to weight development or the risk of developing overweight or obesity. Exposure to low NDVI levels in combination with high NO_x from road traffic and transportation noise as well as long distance to water rendered statistically significant increases in waist circumference in both sexes.

CONCLUSION

Higher long-term exposure to greenness was associated with a reduced increase in waist circumference and lower risk of central adiposity in women but not in men. In both sexes, low NDVI exposure in combination with other environmental risk factors appeared particularly harmful.

Access to public spaces and physical activity for Mexican adult women

The aim of this article was to explore the association between access to public spaces and physical activity for adult women, controlling and testing interactions with sociodemographic and public spaces characteristics. We combined sociodemographic data from a survey with the adult (18-65 years of age) women population of Tijuana, Mexico, conducted in 2014 (N = 2,345); with data from a 2013 study on public spaces in the same city. We evaluated access to public spaces by the presence and total area of public spaces in buffers of 400, 800, 1,000 and 1,600m around the participants’ homes. We measured physical activity with the short version of the International Physical Activity Questionnaire (IPAQ-short). We employed multinomial logistic models to evaluate the association between access to public spaces and physical activity, and tested for interactions between access to public spaces and public spaces quality and sociodemographic characteristics. We observed no interaction between access to public spaces and public spaces quality in their effect on physical activity. There was an association between the presence of public spaces in the 400m buffer, and higher odds of being in the low physical activity level (as opposed to being in the moderate level) (coefficient: 0.50; 95%CI: 0.13; 0.87). Participants who used public transport were less likely to be in the low physical activity level (coefficient: -0.57; 95%CI: -0.97; -0.17). We suggest that, in this population, the access to public spaces might be less relevant for physical activity than other elements of the urban environment and sociodemographic characteristics.

A prescription for "nature" - the potential of using virtual nature in therapeutics

Many studies suggest that increased exposure to urban greenness is associated with better population health. Accessing nature can in some circumstances, however, be difficult, especially for individuals with mobility constraints. Therefore, a growing body of work is investigating the ways to replace the in vivo experience with forms of "virtual" contact, in order to provide these individuals with at least some benefits of the natural environment. The aim of this paper is to provide a review of previous use of virtual reality (VR) nature in health and care settings and contemplate the potential use of this technology in future. Our central question is whether engaging with virtual nature can contribute to enhanced physical and emotional well-being in housebound or mobility-constrained individuals. We conclude that while contact with real-world nature is preferred, VR use can be an alternative in cases when in vivo contact with nature is not possible. There are many possibilities for the use of VR technology in psychiatric and medical care; however, the risks, benefits, and cost efficiency of these attempts should be carefully assessed and the outcomes should be measured in a scientifically valid manner. The current review has nonetheless demonstrated that VR nature could play a role in each of the proposed mediating mechanisms linking natural environments and health.

A Cross-Sectional Investigation of the Importance of Park Features for Promoting Regular Physical Activity in Parks

Introduction: Parks in the US and Australia are generally underutilised, and park visitors typically engage in low levels of physical activity (PA). Better understanding park features that may encourage visitors to be active is important. This study examined the perceived importance of park features for encouraging park-based PA and examined differences by sex, age, parental-status and participation in PA. Methods: Cross-sectional surveys were completed by local residents (n = 2775) living near two parks (2013/2015). Demographic variables, park visitation and leisure-time PA were self-reported, respondents rated the importance of 20 park features for encouraging park-based PA in the next fortnight. Chi-square tests of independence examined differences in importance of park features for PA among sub-groups of local residents (sex, age, parental-status, PA). Results: Park features ranked most important for park-based PA were: well maintained (96.2%), feel safe (95.4%), relaxing atmosphere (91.2%), easy to get to (91.7%), and shady trees (90.3%). All subgroups ranked ‘well maintained’ as most important. Conclusions: Natural and built environment features of parks are important for promoting adults’ park-based PA, and should be considered in park (re)design.

Varying age-gender associations between body mass index and urban greenspace

Urban greenspace benefits urbanites in numerous ways ranging from regulating flooding, air quality, and local climate to providing opportunities for exercise and relaxation. These benefits may influence human health. Greenspace, for example, may facilitate exercise, thereby helping to reduce body mass index (BMI) and combat obesity, a current epidemic of great public health concern. Little evidence exists to support this assertion, however, and we lack a full understanding of the mechanisms whereby this relationship operates, the populations for whom greenspace is linked to weight status, and the aspects of urban greenspace that are linked to weight status. This study seeks to identify relationships among the composition and arrangement of greenspace and BMI for different populations using regression models for eight age and gender groups in Cleveland, Ohio, US. We find that several greenspace variables are related to BMI for women under 65 years and males under 51 years, but not for older groups, and that the aspects and types of greenspace that are significantly related to BMI vary among groups. Relationships between greenspace attributes and BMI are generally stronger for female groups and for younger groups. Providing access to greenspace with particular attributes such as greenspaces with water, canopy cover, or connected greenspaces could support a healthy weight status for some populations, but these attributes are not consistent across age and gender groups. These results could help to inform policy aimed at designing urban greenspace to benefit the health of different population subgroups.

Perceived Health Benefits and Willingness to Pay for Parks by Park Users: Quantitative and Qualitative Research

Whilst a growing body of evidence demonstrates people derive a range of health and wellbeing benefits from visiting parks, only a limited number of attempts have been made to provide a complementary economic assessment of parks. The aim of this exploratory study was to directly estimate the perceived health and wellbeing benefits attained from parks and the economic value assigned to parks by park users in Victoria, Australia. The research employed a mixed methods approach (survey and interviews) to collect primary data from a selection of 140 park users: 100 from two metropolitan parks in Melbourne and 40 from a park on the urban fringe of Melbourne, Victoria. Our findings suggest that park users derive a range of perceived physical, mental/spiritual, and social health benefits, but park use was predominantly associated with physical health benefits. Overall, our exploratory study findings suggest that park users are willing to pay for parks, as they highly value them as places for exercising, socialising, and relaxing. Importantly, most people would miss parks if they did not exist. The findings aim to provide park managers, public health advocates, and urban policy makers with evidence about the perceived health and wellbeing benefits of park usage and the economic value park visitors place on parks.

Is the Association between Park Proximity and Recreational Physical Activity among Mid-Older Aged Adults Moderated by Park Quality and Neighborhood Conditions?

Previous studies have reported mixed findings on the relationship between park proximity and recreational physical activity (PA), which could be explained by park quality and the surrounding neighborhood environment. We examined whether park quality and perceptions of the neighborhood physical and social environment moderated associations between park proximity and recreational PA among mid-older aged adults. Cross-sectional self-reported data on park proximity, park quality, neighborhood physical and social environmental factors, recreational walking and other moderate- to vigorous-intensity recreational physical activity (MVPA) were collected among 2700 Australian adults (57–69 years) in 2012. Main effects between park proximity and measures of recreational PA were non-significant. Park proximity was positively related to engagement in recreational walking among participants who reported average and high social trust and cohesion, but not among those reporting low social trust and cohesion. No other moderating effects were observed. Current findings suggest synergistic relationships between park proximity and social trust and cohesion with mid-older aged adults’ recreational walking. More research is needed to unravel the complex relationship between parks, recreational PA and the social context of neighborhoods.

Frequency of TV viewing and prevalence of overweight and obesity among adult women in Bangladesh: a cross-sectional study

BACKGROUND

Research in developed countries has demonstrated an association of varying degrees between watching TV and the risk of being overweight and obese. However, there is no evidence of such an association in the context of the South Asian population.

OBJECTIVE

To investigate whether watching TV increases the risk of being overweight and obese among women in Bangladesh.

SETTING

Rural and urban areas in Bangladesh.

PARTICIPANTS

Participants were 16 624 non-pregnant women aged between 15 and 49 years.

METHODS

The study was based on cross-sectional data from the Bangladesh Demographic and Health Survey (BDHS) conducted in 2014. The main outcome variables were overweight and obesity measured by body mass index. Data were analysed by using descriptive statistics, cross-tabulation and multivariable logistic regression models.

RESULTS

The prevalence of overweight and obesity in the sample population were, respectively, 4.5% (4.18% to 4.82%) and 20% (95% CI 19.39% to 20.61%). In the multivariable analysis, no statistically significant association was found between watching TV and being overweight. However, the odds of being obese among rural women were 63% higher (adjusted OR (AOR) 1.625, 95% CI 1.179 to 2.241) among those who watched less than once a week, and 68% (AOR 1.683, 95% CI 1.029 to 2.751) higher among women who watched TV at least once a week compared to those who did not watch TV at all. Urban women who watched TV at least once a week were 67% more likely to be obese (AOR 1.665, 95% CI 1.079 to 2.568) compared to those who did not watch at all.

CONCLUSIONS

Prevalence of overweight and obesity has risen considerably among women aged between 15 and 49 years since the previous estimates based on BDHS data. Frequent TV watching was associated with a higher risk of being obese among adult women in rural areas.

The relationship of sport participation to provision of sports facilities and socioeconomic status: a geographical analysis

OBJECTIVE

Ecological models have been applied to investigate multiple domains influencing physical activity behaviour, including individual, social, organisational, community, environmental and policy factors. With regard to the built environment, research to date has been limited to small geographical areas and/or small samples of participants. This study examined the geographical association between provision of sport facilities and participation in sport across an entire Australian state, using objective total enumerations of both, for a group of sports, with adjustment for the effect of socioeconomic status (SES).

METHODS

De-identified membership registration data were obtained from state sport governing bodies of four popular team sports. Associations between participation rate, facility provision rate and SES were investigated using correlation and regression methods.

RESULTS

Participation rate was positively associated with provision of facilities, although this was complicated by SES and region effects. The non-metropolitan region generally had higher participation rates and better provision of facilities than the metropolitan region.

CONCLUSIONS

Better provision of sports facilities is generally associated with increased sport participation, but SES and region are also contributing factors. Implications for public health: Community-level analysis of the population, sport participation and provision of facilities should be used to inform decisions of investments in sports facilities.