Dose-response effect of a large-scale greenway intervention on physical activities: The first natural experimental study in China

The effectiveness of new urban trail infrastructure on physical activity and active transportation: a systematic review and meta-analysis of natural experiments

BACKGROUND

Cities in Western countries are investing billions of dollars in new cycling infrastructure (urban trails) to support active transportation (AT) and leisure-type physical activity (PA). Little empirical evidence exists on the effectiveness of urban trails on changes in AT or PA.

DESIGN AND METHODS

We searched CINAHL, OVID, SPORTDiscus, Transport Research International Documentation (TRID), Web of Science Core Collection and Google Scholar for articles published from 2010 to 2023. We included controlled experimental studies that reported PA, AT or trail counts as outcome measures before and after construction of an urban trail. A modified risk of bias tool was employed to assess the methodological quality of each selected study (Prospero ID: CRD42023438891).

RESULTS

Three independent reviewers screened abstracts from 3936 articles identified in the original search and identified 24 articles that met inclusion criteria: 11 studies (n = 11,464) that measured changes in PA, 8 studies (n = 92,001) that measured changes in cycling traffic and 5 studies (n = 4,958,203) that measured changes in rates of AT/cycling. Meta-analysis revealed that new trails increased PA levels among individuals in proximity to one, compared to those living in control areas (SMD = 0.12; 95% CI: 0.04, 0.20; I2 = 73%; n = 11,464). This effect was marginally stronger when data were restricted to individuals living in closest proximity to trails (SMD = 0.14; 96% CI: 0.06 to 0.25, I2 = 74%; n = 8234). Meta-analyses were not possible for measures of AT and cycling counts. All studies were at high risk of bias due to a failure to adhere to reporting guidelines for quasi-experimental studies.

CONCLUSIONS

There is limited but intriguing evidence that the addition of protected urban trails increases daily PA for individuals living in neighbourhoods that receive them. The strength of this evidence could be enhanced with the application of and adherence to principles of causal inference and increased diversity of individuals included in study designs.

Daily walking time effects of the opening of a multifunctional facility "ONIKURU" using propensity score matching and GPS tracking techniques

Urban design focused on improving walkability has received attention as a method of increasing physical activity among the population. However, only a few studies have examined the effect of walking time of opening multifunctional facilities as an architecture-scale intervention. This study aimed to clarify the effect of opening a multifunctional facility on residents' daily walking time. In addition, this study analyzed the gender and age subgroups. The natural experiment was conducted using the case of the Ibaraki City Cultural and Childcare Complex "ONIKURU," a public multifunctional facility. This study used GPS-trajectory data based on GPS tracking techniques, which is anonymized location data for smartphone users. The causal relationship was analyzed using propensity score matching and difference-in-differences analysis. The results showed that the opening of ONIKURU significantly increased the average walking time of visitors to 3.165 [- 1.697, 8.027] min/day compared with that of non-visitors. Specifically, visitors' average daily walking time improved to a level comparable to that of non-visitors after the opening of ONIKURU. In addition, opening ONIKURU significantly increased female young adults' average walking time to 3.385 [- 4.906, 11.676] min/day. Therefore, this study provides theoretical contributions to a health-promoting built environment significantly affecting walking at an architecture-scale intervention.

Are Neighborhood Greenspaces Associated with Leisure-time Physical Activity? Results from ELSA-Brasil Eight-year Follow-up

We investigated whether neighborhood greenspaces were associated with physical activity in adulthood over 3 cohort visits after considering perceived safety and neighborhood contextual factors. We also evaluated whether the association with greenspace varied by neighborhood socioeconomic status. Participants (N = 4,800) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) residing in two Brazilian state capitals were evaluated in Visits 1 (2008-2010), 2 (2012-2014) and 3 (2017-2019). Greenspaces were categorized by quintiles of positive Normalized Difference Vegetation Index (NDVI) scores. Physical activity frequency was given by the number of visits at which participants reported moderate/vigorous physical activity (none, 1 or 2, and 3 visits). We used multinomial logistic regression. After adjustment for age, sex, education, research center, residence in slums, individuals in the 4th and 5th NDVI quintiles showed 73% higher odds of physical activity over 3 visits than those in the 1st quintile (4th quintile: 95%CI = 1.24-2.43; 5th quintile: 95%CI = 1.24-2.41). The strength of the association was attenuated after adjustment for perceived safety. After adjustment for contextual factors quantity of sidewalks and streetlights, the OR for the 4th and 5th NDVI quintiles decreased to 1.66 (95%CI = 1.18-2.33) and 1.62 (95%CI = 1.16-2.28), respectively. Finally, after including average household income per capita, the OR for physical activity in 3 visits for the 4th and 5th NDVI quintiles decreased to 1.48 (95%CI = 1.04-2.12) and 1.43 (95%CI = 1.00-2.04; p = 0.053), respectively. Greater greenspace contributed to sustained physical activity during the eight years of follow-up, indicating the potential contribution of public greenspaces to reducing health-related inequalities.

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.

Building running-friendly cities: effects of streetscapes on running using 9.73 million fitness tracker data in Shanghai, China

The association between built environment and physical activity has been recognized. However, how and to what extent microscale streetscapes are related to running activity remains underexplored, partly due to the lack of running data in large urban areas. Moreover, few studies have examined the interactive effects of macroscale built environment and microscale streetscapes. This study examines the main and interactive effects of the two-level environments on running intensity, using 9.73 million fitness tracker data from Keep in Shanghai, China. Results of spatial error model showed that: 1) the explanatory power of microscale streetscapes was higher than that of macroscale built environment with R2 of 0.245 and 0.240, respectively, which is different from the prior finding that R2 is greater for macroscale built environment than for microscale streetscape; 2) sky and green view indexes were positively associated with running intensity, whereas visual crowdedness had a negative effect; 3) there were negative interactions of land use Herfindahl-Hirschman index with sky and green view indexes, while a positive interaction was observed for visual crowdedness. To conclude, greener, more open and less visually crowded streetscapes, can promote running behavior and enhance the benefits of land use mix as well. The findings highlight the importance of streetscapes in promoting running behavior, instead of a supplement to macroscale built environment.

Effects of virtual exposure to urban greenways on mental health

Urban greenways (UGW) are increasingly recognized as vital components of urban green infrastructure (UGI). While existing research has provided empirical evidence on the positive impacts of UGW on physical health, studies focusing on the effects on mental health remain limited. Moreover, previous investigations predominantly compare UGW as a whole with other built environments, neglecting the influence of specific vegetation designs along UGW on mental health. To address this research gap, we conducted a randomized controlled experiment to examine the impact of vegetation design along UGW on stress reduction and attention restoration. A total of 94 participants were randomly assigned to one of four UGW conditions: grassland, shrubs, grassland and trees, or shrubs and trees. Utilizing immersive virtual reality (VR) technology, participants experienced UGW through a 5-min video presentation. We measured participants' subjective and objective stress levels and attentional functioning at three time-points: baseline, pre-video watching, and post-video watching. The experimental procedure lasted approximately 40 minutes. Results of the repeated-measures ANOVA revealed that participants experienced increased stress and mental fatigue after the stressor and decreased levels following the UGW intervention. Furthermore, between-group analyses demonstrated that the shrubs group and the grassland and trees group exhibited significantly greater stress reduction than the grassland group. However, there are no significant differences in attention restoration effects between the four groups. In conclusion, virtual exposure to UGW featuring vegetation on both sides positively affected stress reduction and attention restoration. It is recommended that future UGW construction incorporates diverse vegetation designs, including shrubs or trees, instead of solely relying on grassland. More research is needed to explore the combined effects of shrubs and trees on mental health outcomes.

Greenway interventions effectively enhance physical activity levels-A systematic review with meta-analysis

Background

Previous studies have examined the impact of greenway interventions on physical activity (PA); however, the results have been inconclusive. In order to address this issue, our study conducted a systematic review with meta-analysis to thoroughly evaluate the evidence and determine the effectiveness of greenway interventions in promoting PA.

Methods

We conducted a comprehensive search of literature databases, such as Web of Science, EMBASE, PubMed (via Medline), Cochrane Library, and Scopus, up to June 15, 2023. To synthesize the available evidence, we performed a meta-analysis using a random effects model. The quality of the included studies was assessed using the criteria developed by the Agency for Healthcare Research and Quality and the Newcastle-Ottawa Scale.

Results

A total of 9 publications were identified, involving 6, 589 individuals. The overall quality of most included studies was rated as moderate to high. Our study found that the greenway was effective in promoting PA among participants. Specifically, active travel (AT) showed a standard mean difference (SMD) of 0.10 [95% confidence interval (CI): 0.04 to 0.17], moderate-to-vigorous PA had an SMD of 0.11 (95% CI: 0.02 to 0.20), and total PA had an SMD of 0.14 (95% CI: 0.06 to 0.21). We also observed significant differences in AT levels among participants based on greenway characteristics, exposure distance, exposure duration, and male-to-female ratio.

Discussion

Newly developed or upgraded greenways have been shown to effectively promote PA. Additionally, research suggests that the longer a greenway has been in existence, the greater the benefits it provides for PA. As a result, the construction of greenways should be recognized as an effective public health intervention.

Does the Installation or the Improvement of Existing Outdoor Parks Increase Physical Activity Levels? A Systematic Review

Investment in outdoor parks is proposed as a promising large-scale strategy to promote physical activity (PA). This study aimed to systematically review the impact of park renovations or installing new ones in increasing PA. Searches were conducted using predefined terms in three databases (PubMed, Scopus, and Web of Science) in March 2022. Studies examining the effectiveness of park renovations or developing new ones in increasing PA and having control or comparison were eligible for inclusion. Study quality was assessed using the Quality Assessment Tool for Quantitative Studies. Data were extracted from the included records using a predefined extraction table. The database search yielded 959 records, and 26 were included. For park renovations (n = 17), 11 (65%) studies presented findings supporting a positive effect on PA. The other six (35%) studies found no PA benefits when compared to control or pre-renovations/improvement levels. Regarding new installations (n = 9), five (56%) studies presented improvements in PA, and four (44%) did not. A promising positive impact of park renovations and new installations on park use and PA was observed. The review findings reflect the need to understand the context, daily routines, and interests of the surrounding population before renovating or installing new outdoor parks.

12-week concurrent brisk walking and Taijiquan (Tai Chi) improve balance, flexibility, and muscular strength of Chinese older women

Healthy aging is a global goal to enhance the quality of life for older persons. This study evaluated the benefits of 12-week concurrent brisk walking and Taijiquan. Healthy Chinese women aged 60 years and above were enrolled to the control (n = 26) and intervention (n = 25) groups. Participants in the intervention group engaged in three exercise sessions per week for 12 weeks, whereas control group engaged in free-living activities. Each exercise session consisted of 20-45 minutes of walking and 20-45 minutes of Yang style 24-form Taijiquan. 12-week exercise improved (p < 0.05) the sit and reach test (within-group mean difference: +5.6 cm; Hedges' g = 0.77), handgrip strength (mean difference: +3.1 kg; g = 0.89), arm curl (mean difference: +2.1 repetitions; g = 0.69), chair stand (mean difference: +2.6 repetitions; g = 0.63), and one-legged standing (mean difference: +2.2 seconds; g = 1.07). There was no improvement in the circulatory health, body composition, or life satisfaction. Therefore, this concurrent brisk walking and Taijiquan training, which targets major whole-body muscle groups, could improve aging-critical flexibility, muscular fitness, and balance in older women. The exercise meets the current WHO guideline, is safe to perform, and could be campaigned as a health promotion for older persons.

Effects of green space on physical activity and body weight status among Chinese adults: a systematic review

Background

Green space may provide many benefits to residents' health behaviors and body weight status, but the evidence is still relatively scattered among Chinese adults. The purpose of this study was to review the scientific evidence on the effects of green space on physical activity (PA) and body weight status among Chinese adults.

Methods

A keyword and reference search was conducted in Pubmed, Web of Science, MEDLINE, and PsycINFO. Studies examining the associations between green space and PA, body mass index (BMI) among Chinese adults were included. The quality of the included literature was evaluated using the National Institutes of Health's Observational Cohort and Cross-Sectional Study Quality Assessment Tool.

Results

A total of 31 studies were included that met the inclusion criteria, including 25 studies with a cross-sectional design, 3 studies with a longitudinal design, and 3 studies with an experimental design. Street-level green view index and green space accessibility were found to be positively associated with PA, but negatively associated with BMI. In most studies, there was a correlation between green space ratio in local areas and BMI. In addition, green space interventions were effective in increasing PA and decreasing BMI among Chinese adults. In contrast, further evidence is needed to support the association between the design characteristics of green space and PA and BMI.

Conclusion

Preliminary evidence suggests that green space has a positive effect on PA and BMI among Chinese adults. However, there are contradictory findings, and future studies adopting longitudinal and quasi-experimental studies are needed to further explore the causal relationship between green space and PA and BMI to provide a relevant theoretical basis for policymakers.

The association between residential greenness and hearing impairment

Growing evidence shows that residential greenness is beneficial for various health outcomes, but the link between residential greenness and hearing impairment has not been explored. We aimed to explore the link between residential greenness and hearing impairment using baseline data from the UK Biobank. We used data from 107,516 participants between the ages of 40 and 69 years in the UK Biobank from 2006 to 2010. The normalized difference vegetation index (NDVI) was used to measure the residential greenness. We defined hearing impairment using the digital triplet test. Logistic regression models were conducted to examine the association of residential greenness with hearing impairment. Each interquartile increment in NDVI was associated with 19% lower odds of hearing impairment (odds ratio, OR 0.81; 95% confidence interval, 95% CI 0.79-0.83). Compared with participants in the first NDVI quartile, those in the second, third, and fourth NDVI quartiles had lower odds of hearing impairment (OR 0.69, 95% CI 0.65-0.73 for the second; OR 0.76, 95% CI 0.72-0.81 for the third; OR 0.68, 95% CI 0.65-0.72 for the fourth). Age and Townsend deprivation index showed moderating effects on this association. Our findings showed a negative association between residential greenness and hearing impairment, which might provide potential value for developing cost-effective greenness design and configuration interventions to reduce the risk of hearing impairment.

Estimating the impact of nutrition and physical activity policies with quasi-experimental methods and simulation modelling: an integrative review of methods, challenges and synergies

BACKGROUND

The promotion of healthy lifestyles has high priority on the global public health agenda. Evidence on the real-world (cost-)effectiveness of policies addressing nutrition and physical activity is needed. To estimate short-term policy impacts, quasi-experimental methods using observational data are useful, while simulation models can estimate long-term impacts. We review the methods, challenges and potential synergies of both approaches for the evaluation of nutrition and physical activity policies.

METHODS

We performed an integrative review applying purposive literature sampling techniques to synthesize original articles, systematic reviews and lessons learned from public international workshops conducted within the European Union Policy Evaluation Network.

RESULTS

We highlight data requirements for policy evaluations, discuss the distinct assumptions of instrumental variable, difference-in-difference, and regression discontinuity designs and describe the necessary robustness and falsification analyses to test them. Further, we summarize the specific assumptions of comparative risk assessment and Markov state-transition simulation models, including their extension to microsimulation. We describe the advantages and limitations of these modelling approaches and discuss future directions, such as the adequate consideration of heterogeneous policy responses. Finally, we highlight how quasi-experimental and simulation modelling methods can be integrated into an evidence cycle for policy evaluation.

CONCLUSIONS

Assumptions of quasi-experimental and simulation modelling methods in policy evaluations should be credible, rigorously tested and transparently communicated. Both approaches can be applied synergistically within a coherent framework to compare policy implementation scenarios and improve the estimation of nutrition and physical activity policy impacts, including their distribution across population sub-groups.

Nonlinear Effects of the Built Environment on Light Physical Activity among Older Adults: The Case of Lanzhou, China

The aging of the population is increasing the load on the healthcare system, and enhancing light physical activity among older adults can alleviate this problem. This study used medical examination data from 1773 older adults in Lanzhou city (China) and adopted the random forest model to investigate the effect of the built environment on the duration of light physical activity of older adults. The results showed that streetscape greenery has the most significant impact on older adults' light physical activity; greenery can be assessed in a hierarchy of areas; population density and land-use mix only have a positive effect on older adults' light physical activity up to a certain point but a negative effect beyond that point; and a greater distance to the park within 1 km is associated with a longer time spent on light physical activity. Therefore, we conclude that the built environment's impact is only positive within a specific range. Changes in the intervention of environmental variables can be observed visually by calculating the relative importance of the nonlinearity of built environment elements with partial dependency plots. These results provide a reasonable reference indicator for age-friendly community planning.

Examining the Dose-Response Relationship between Outdoor Jogging and Physical Health of Youths: A Long-Term Experimental Study in Campus Green Space

Many studies have demonstrated that outdoor physical activity positively affects the physical health of young people. Here, we aimed to examine the extent to which outdoor jogging was associated with the physical health of youths, and then to decipher whether a dose–response relationship exists between them. A total of 2852 youths from a Chinese university were enrolled in a long-term experimental study between September 2018 and September 2019. We conducted two waves of physical health tests for 2852 youths (before and after the jogging interventions in 2018 and 2019, respectively) using China’s National Student Physical Health Standard (NSPHS). Paired t-tests were used to examine statistical differences. A multiple regression model was used to evaluate the associations between jogging and physical health. The results showed that: statistically significant changes in the two waves of physical health outcomes were suggested after jogging interventions; outdoor jogging in campus green space was associated with participants’ physical health after controlling for covariates; and a dose–response relationship between jogging and physical health outcomes was revealed, with 120–140 km/year (approximately 3.43–4 km/week) being the most effective intervention dose. Our findings have implications for promoting physical health in youth groups by encouraging outdoor physical activity.

Evaluation of the Health Promotion Capabilities of Greenway Trails: A Case Study in Hangzhou, China

As a type of green infrastructure, greenways are beneficial for walking and cycling and promote urban health and well-being. Taking the Qingshan Lake Greenway Phase One (QLG-I) Trail in the Lin’an District of Hangzhou city as an example and based on the accessibility of points of interest (POI) near the QLG-I Trail, a questionnaire investigation, and an importance performance analysis (IPA), in this paper, we construct a methodological framework to evaluate the health-promotion capabilities of the QLG-I Trail, including three aspects: promoting the coverage of healthy travel, user attribute analysis, and user perceptions of the greenway for health promotion. The results show that the healthy travel range of the QLG-I Trail is small and that the users are mainly residents of nearby communities. Additionally, the main factors affecting users’ health-promoting behaviour are safety, cleanliness, and infrastructure services. Although the overall satisfaction with service quality was good (3.93), we found that the trail facilities did not meet the needs of the users. This study confirms that the QLG-I Trail provides community residents with a place for sports activities and supports health-promoting behaviour. Greenway facilities and the natural environment enhance this utility; however, promoting the coverage of healthy travel is limited by accessibility. Finally, we propose a traffic-organization optimization and improvement plan for the QLG-I Trail. The research results may help promote healthy activities on this type of greenway.

Amount of and proximity to blue spaces and general health among older Chinese adults in private and public housing: A national population study

A growing body of research indicates that exposure to outdoor blue spaces is associated with better physical and mental health. However, few studies have explored the associations between different blue space indicators (e.g., amount of and proximity to freshwater and seawater) and general health. Moreover, research has rarely attempted to address the residential selection bias associated with the salutogenic effect of access to blue spaces. Therefore, this study explores the associations between the amount (percentage of blue space within a 1 km circular buffer) of and proximity (Euclidean distance to the edge of the nearest blue space) to blue space and older adults' general health across the entire country of China using the micro-data sample of one-percent national population sample survey in 2015. It adds to the existing literature by taking into account the neighbourhood selection mechanism for different housing tenures and examining the salutogenic effect of blue spaces separately for public housing residents and private housing residents. The results indicated that greater neighbourhood seawater coverage and living near a coastline were associated with better general health among older adults in both private and public housing, while the percentage of freshwater blue spaces within neighbourhoods and the distance to freshwater blue spaces were associated with better general health among private housing residents only. The blue spaces-general health associations were stronger among urban participants, participants in deprived neighbourhoods, males, participants aged under 80 years, and low- and medium-educated participants. Our findings indicated that living near the coast was beneficial to older adults' health, and residential selection bias confounded the association between freshwater blue spaces and health.

Factors Influencing Users' Perceived Restoration While Using Treetop Trails: The Case of the Fu and Jinjishan Forest Trails, Fuzhou, China

Studies have indicated that urban greenways promote physical and perceived restoration. However, there is a lack of research on the impact of treetop trails on human perceived restoration. In this study, two representative treetop trails in Fuzhou city were selected to investigate treetop trails’ impact on users’ perceived restoration. The study adopted a structural equation modelling approach to explore the influence mechanisms and pathways of treetop trails on users’ perceived restoration, through 412 questionnaires. The results showed that the perceived environmental quality of treetop trails had a significant positive effect on users’ overall psychological wellbeing. Place attachment had a significant positive effect on users’ perceived restoration and a significant mediating effect on users’ perceived environmental quality of trails. The results of this study revealed that the mechanisms of the impact of treetop trails on users’ perceived restoration and the construction of treetop trails can be enhanced in the future by improving trail facilities, enriching trail perception of elevated feeling, improving trail landscape quality, and optimising trail design.

Can parkland mitigate mental health burden imposed by the COVID-19? A national study in China

The worldwide coronavirus disease 2019 (COVID-19) pandemic has seriously affected not only physical health but also mental wellbeing (i.e mental stress and suicide intention) of numerous urban inhabitants across the globe. While many studies have elucidated urban parkland enhances and mental wellbeing of urban residents, the potential for parkland to mitigate mental health burden imposed by the COVID-19 has received no attention. This nationwide study systematically explored the association between parkland, the COVID-19 pandemic situation and mental wellbeing from 296 cities in China. The study innovatively used big data from Baidu Search Engine to assess city-level mental wellbeing, thereby enabling comparisons among cities. The results show that the provision of parkland is positively associated with mental wellbeing during the COVID-19 epidemic. For COVID-19-related indicators, the geographical distance to Wuhan city, work resumption rate, and travel intensity within the city are also positively associated with mental wellbeing, while the number of COVID-19 infections and the proportion of migrants from Hubei Province for each city are negatively associated with mental wellbeing. Last, the most important finding is that parkland reduces the negative effect of COVID-19 on mental wellbeing during the COVID-19 epidemic. To achieve the goal of promoting mental wellbeing through urban planning and design during the future pandemics, policymakers and planners are advised to provide more well-maintained and accessible parkland and encourage residents to use them with proper precautions.

Associations of residential walkability and greenness with arterial stiffness in the UK Biobank

BACKGROUND

Arterial stiffness is a key non-invasive marker of early vascular ageing, however, little is known of its associations with urban built environment. We examined the associations of objectively-measured residential walkability and greenness with arterial stiffness in a large UK-wide population cohort.

METHODS

We employed data from the baseline UK Biobank cohort comprising adult participants recruited over the period of 2006 to 2010. Residential walkability index, defined as a function of density (residential, retail and public transit), street-level design, and destination accessibility was measured using a 1-Km dwelling catchment, while greenness was modelled as the mean Normalized Difference Vegetation Index (NDVI) of 0.5-metre resolution assessed within a 0.5-Km catchment. Arterial stiffness index (ASI) was measured non-invasively from the pulse waveform. Linear regression models were developed to examine associations of walkability and greenness with arterial stiffness. Restricted cubic spline (RCS) models were developed to examine dose-response relationships. We also examined effect modifications by sex and age, as well as the interaction effect of greenness and walkability.

RESULTS

This cross-sectional study used a target sample of 169,704 UK Biobank participants aged ≥ 39 years. After full adjustments, in reference to the lowest walkability exposure quartile, those in the highest were associated with lower ASI (β = -0.083 m/s, 95% CI: -0.14 to -0.03, p = 0.005). Participants in the third and fourth NDVI greenness exposure quartiles were also associated with lower ASI (β = -0.074 m/s, -0.14 to -0.01, p < 0.020 for the third and β = -0.293 m/s, -0.36 to -0.23, p < 0.001 for the fourth quartiles in reference to the first). The inverse association between NDVI greenness and ASI was more pronounced among women (p < 0.001), older adults (p = 0.011) and among participants in the highest walkability quartile (p < 0.001).

CONCLUSION

Designing more walkable and greener residential environments can be a preventive intervention aimed at lowering the population distribution of vascular ageing and associated cardiovascular risks.

Exploring the spatial scale effects of built environments on transport walking: Multi-Ethnic Study of Atherosclerosis

We employed a longitudinal distributed lag modeling approach to systematically estimate how associations between built environment features and transport walking decayed with the increase of distance from home to built environment destinations. Data came from a cohort recruited from six U.S. cities (follow-up 2000-2010, N = 3913, baseline mean age 60). Built environment features included all walkable destinations, consisting of common and popular destinations for daily life. We also included two subsets frequent social destinations and food stores to examine if the spatial scale effects differed by varying density for different types of built environment destinations. Adjusted results found that increases in transport walking diminished when built environment destinations were farther, although distance thresholds varied across different types of built environment destinations. Higher availability of walking destinations within 2-km and frequent social destinations within 1.6-km were associated with transport walking. Food stores were not associated with transport walking. This new information will help policymakers and urban designers understand at what distances each type of built environment destinations influences transport walking, in turn informing the development of interventions and/or the placement of amenities within neighborhoods to promote transport walking. The findings that spatial scales depend on specific built environment features also highlight the need for methods that can more flexibly estimate associations between outcomes and different built environment features across varying contexts, in order to improve our understanding of the spatial mechanisms involved in said associations.

Effects and Environmental Features of Mountainous Urban Greenways (MUGs) on Physical Activity

The role played by urban greenways in supporting physical activity (PA) for public health benefits has been receiving increasing attention. Most studies on this topic have been conducted in plains, whereas studies in mountainous regions have been limited as a result of the complexity of these areas. To address this knowledge gap, this article aims to analyze the effects of the environmental features for a mountainous urban greenway (MUG) on PA, leading to better support for greenway practice in mountainous areas. A volunteered geographic information (VGI) method was applied through the mobile app KEEP to collect 1314 valid records of PA including its density (total PA distance per unit area within the buffer zone) and attributes (distance, duration and speed) in the Yuzhong Peninsula, Chongqing, China. Similar to those of the studies conducted in the plains, our results showed that PA density was affected by the MUG and its surrounding environment. The key environmental features included residential density, open-space POI, the slope, the transportation-MUG (T-MUG) ratio and the recreational-MUG (R-MUG) ratio. For the PA attributes, the MUG showed stronger effects than the surrounding environment. The key environmental features included the slope and type of MUG, of which the former was negatively associated with distance and speed. The T-MUG ratio was positively related to duration and speed, while the R-MUG ratio was positively related to duration and distance. No association was found between livelihood (L-MUG) and PA. Hence, to support both the PA density and attributes, the environmental qualities for recreation and the types of R-MUGs should be given more consideration in practice.

Urban greenery cushions the decrease in leisure-time physical activity during the COVID-19 pandemic: A natural experimental study

The coronavirus disease 2019 (COVID-19) pandemic and related social distancing measures have altered the daily lifestyles of people worldwide. Although studies on this disease are emerging rapidly, less is known about the impacts of COVID-19 and urban greenery on leisure-time physical activity, which is critical to maintain health for urban residents during the pandemic. In this study, we used a natural experimental research design to identify whether urban greenery cushions the decrease in leisure-time physical activity caused by the pandemic and related social distancing measures in a high-density city. The two-wave physical activity data (before and during the pandemic) were collected for urban residents in neighborhoods with high or low levels of greenery. The results of difference-in-differences model suggest that urban greenery mitigated the decrease in physical activity during the pandemic. People who lived in greener neighborhoods experienced a lesser decrease in the leisure-time physical activity level than those who lived in less green neighborhoods. Additionally, people who lived in greener neighborhoods experienced increased levels of physical activity related to visits to country parks during the pandemic. These findings suggest that urban green spaces play a significant role in shaping physical activity and providing a refuge for the public during crises. Our study is among the first to investigate the impact of urban greenery on pandemic-induced changes in leisure-time physical activity in densely populated Asian cities, and our findings shed light on the potential protective role of urban greenery on public health during the COVID-19 pandemic and beyond.

Longitudinal associations between neighbourhood physical environments and depressive symptoms of older adults in Hong Kong: The moderating effects of terrain slope and declining functional abilities

Little is known about the accumulative impacts of neighbourhood physical environments on older adults' depressive symptoms over time. Based on a cohort study of 2081 older adults in Hong Kong, this study examined longitudinal relationships between neighbourhood physical environments and depressive symptoms among older adults, with a particular focus on the moderating effects of terrain slope and individual functional ability using latent growth curve modelling. Results indicated that the availability of community centres and passive leisure facilities reduced depressive symptoms over time. The protective effects of residential surrounding greenness on depressive symptoms among older adults differed by the terrain slope types. Longitudinal associations between neighbourhood physical environments and depressive symptoms varied between older adults with and without functional limitations. This study has implications for the Ecological Theory of Ageing by identifying the dynamic interplay of environment demands and individual functional ability. Planning policies for building age-friendly neighbourhoods are discussed.

Greenness-air pollution-physical activity-hypertension association among middle-aged and older adults: Evidence from urban and rural China

BACKGROUND

Although some evidence suggests that residential greenness may prevent hypertension in urban areas, limited attention has been paid to urban-rural disparities in the association of greenness with hypertension in rapidly urbanizing developing countries.

OBJECTIVES

The current study investigated the association between the amount of neighbourhood greenness and hypertension among middle and older aged people in Chinese urban and rural areas. It further examined whether PM_2.5 (particulate matter ≤2.5 μm in aerodynamic diameter) concentrations, physical activity, and body mass index (BMI) mediated the association of greenness with hypertension.

METHODS

We used data from 11 486 adults aged 50 years or above within the first wave of the Study on Global Ageing and Adult Health in China during 2007-2010. Hypertension was assessed by criterion-based measures of blood pressure. Residential greenness was characterized by satellite-derived Normalized Difference Vegetation Index. We employed multilevel generalized structural equation models to estimate the association between neighbourhood greenness and hypertension in urban and rural areas. Serial mediation models have been performed to test potential pathways linking greenness to hypertension.

RESULTS

In rural areas, a greater amount of residential greenness was directly associated with a decrease in the odds of hypertension (odds ratio = 0.51, 95% confidence interval 0.29-0.89). No direct association was observed in urban areas (odds ratio = 1.33, 95% confidence interval 0.94-1.89). Serial mediation models showed that the association of greenness with hypertension was completely mediated by PM_2.5 concentrations in urban areas, while the association of greenness with hypertension was only partially mediated by PM_2.5 concentrations and serial PM_2.5 concentrations-physical activity path in rural areas. There was no evidence that physical activity, air pollution-BMI path, air pollution-physical activity-BMI path, and physical activity-BMI path mediated the association in both urban and rural areas.

CONCLUSIONS

Higher neighbourhood greenness was directly associated with a lower prevalence of hypertension among middle and older aged adults in rural China but not in urban areas. The association of greenness with hypertension was completely mediated by air pollution (without any mediation effect of physical activity and BMI) in urban areas. In contrast, the association was partly mediated by air pollution, physical activity, and other unobservables in rural areas. Further longitudinal studies are warranted to prove a cause-and-effect association, which may help policymakers and practitioners to conduce effective interventions to prevent and control the prevalence of hypertension and the attendant disease burden.