Perceived neighborhood environment and walking for specific purposes among elderly Japanese

A Scoping Review of Personal, Financial, and Environmental Determinants of Mobility Among Older Adults

OBJECTIVE

To synthesize available evidence of factors comprising the personal, financial, and environmental mobility determinants and their association with older adults' self-reported and performance-based mobility outcomes.

DATA SOURCES

PubMed, EMBASE, PsychINFO, Web of Science, AgeLine, Sociological Abstract, Allied and Complementary Medicine Database, and Cumulative Index to Nursing and Allied Health Literature databases search for articles published from January 2000 to December 2021.

STUDY SECTION

Using predefined inclusion and exclusion criteria, multiple reviewers independently screened 27,293 retrieved citations from databases, of which 422 articles underwent full-text screening, and 300 articles were extracted.

DATA EXTRACTION

The 300 articles' information, including study design, sample characteristics including sample size, mean age and sex, factors within each determinant, and their associations with mobility outcomes, were extracted.

DATA SYNTHESIS

Because of the heterogeneity of the reported associations, we followed Barnett et al's study protocol and reported associations between factors and mobility outcomes by analyses rather than by article to account for multiple associations generated in 1 article. Qualitative data were synthesized using content analysis. A total of 300 articles were included with 269 quantitative, 22 qualitative, and 9 mixed-method articles representing personal (n=80), and financial (n=1), environmental (n=98), more than 1 factor (n=121). The 278 quantitative and mixed-method articles reported 1270 analyses; 596 (46.9%) were positively and 220 (17.3%) were negatively associated with mobility outcomes among older adults. Personal (65.2%), financial (64.6%), and environmental factors (62.9%) were associated with mobility outcomes, mainly in the expected direction with few exceptions in environmental factors.

CONCLUSIONS

Gaps exist in understanding the effect of some environmental factors (eg, number and type of street connections) and the role of gender on older adults' walking outcomes. We have provided a comprehensive list of factors with each determinant, allowing the creation of core outcome set for a specific context, population, or other forms of mobility, for example, driving.

The Impact of the Built Environment and Social Environment on Physical Activity: A Scoping Review

This scoping review aims to provide an overview of the current state of physical activity research, focusing on the interplay between built and social environments and their respective influences on physical activity. We comprehensively searched electronic databases to identify relevant studies published between 2000 and 2022. A total of 35 articles have been reviewed based on the research question. The review found that built and social environments influence physical activity, and consideration of people's perceptions of their surroundings can provide further insight. The literature was summarized, and recommendations were made for future research. Findings suggest that interventions targeting built and social environments can promote physical activity effectively. However, limitations in the literature exist, including a need for more standardization in research methods and consistency in measurement tools.

Psychosocial and environmental factors related to physical activity in middle-aged and older adults

The social ecological model provides a comprehensive framework for understanding the multiple-level determinants of physical activity. This study explores the significant individual, social, and environmental variables and their interactions in relation to physical activity in middle-aged and older adults in Taiwan. A cross-sectional study design was implemented. Healthy middle-aged and older adults were recruited (n = 697) through face-to-face and online surveys. The data collected comprised self-efficacy, social support, neighbourhood environment, and demographic characteristics. Hierarchical regression was used for statistical analysis. Self-rated health (B = 74.74, p < .001; B = 101.45, p = .022) and self-efficacy (B = 17.93, p < .001; B = 14.95, p = .020) were the significant individual variables in both middle-aged and older adults. Neighbourhood environment (B = 6.90, p = .015) and the interaction between self-efficacy and neighbourhood environment (B = 1.56, p = .009) were significant in middle-aged adults. Self-efficacy was the most significant predictor for all participants, with the positive correlations of neighbourhood environment arising only for middle-aged adults with high self-efficacy. Policy making or project design should consider multilevel factors in order to facilitate their physical activity.

Walking Behavior of Older Adults in Temuco, Chile: The Contribution of the Built Environment and Socio-Demographic Factors

The amount of walking for daily transport has decreased significantly over the last decades in Temuco, Chile. Moreover, the percentage of older adults (aged over 65) who did not meet the recommendations of at least 150 min of physical activity per week has increased during this time. In this regard, the present study examines the contribution of socio-demographic and built environment factors on the walking behavior of older adults in Temuco, Chile, with a view to improving their level of physical activity. A cross-sectional study was conducted among 463 older adults aged 60 years and over. Travel Diary Data taken from "Encuesta Origin Destino" (EOD) 2013, Geographic information systems (GIS), audits (PEDS with certain revisions) and finally, multiple regression analysis, were used to examine the objectives. Associations were found between the walking behavior of older adults and several socio-demographic factors, as well as several built environment factors including destination (the number of parks and the land use mix), functionality (street connectivity, length of street sections and off-street parking lots) and aesthetics (views of nature, building height, and articulation in building design). These findings should be considered by urban/transport policymakers to improve the walking behavior of older adults in this city.

The Effects of Neighborhood Physical and Social Environment on Physical Function among Japanese Community-Dwelling Older Adults: A One-Year Longitudinal Study

Previous studies have shown a relationship between physical and social aspects of the neighborhood environment (e.g., built environment, safety) and physical function in older adults. However, these associations are unclear in older Asian adults because longitudinal studies are lacking. This study examined the effects of neighborhood physical and social environment on longitudinal changes in physical function among Japanese older adults. We analyzed 299 Japanese community-dwelling adults aged ≥65 years. Neighborhood environment was assessed using the International Physical Activity Questionnaire Environment Module. Physical function was assessed using handgrip strength, knee extension muscle strength, 5-m walking time, and a timed up-and-go test (TUG) in baseline and follow-up surveys. Changes in physical function over one year were calculated and classified into decline or maintenance groups based on minimal detectable changes. Multiple logistic regression analysis showed that even after adjusting for confounding factors, good access to recreational facilities affected the maintenance of 5-m walking time (odds ratio [OR] = 2.31, 95% confidence interval [CI]: 1.02–5.21) and good crime safety affected the maintenance of TUG (OR = 1.87, 95%CI: 1.06–3.33). Therefore, it is important to assess both physical and social environmental neighborhood resources in predicting decline in physical function among Japanese older adults.

Walking Behavior in Temuco, Chile: The Contribution of Built Environment and Socio-Demographic Factors

The increase in active travel contributes to maintaining the minimum rate of physical activity and therefore has a positive impact on inhabitants’ public health. The level of walking for daily transport has decreased significantly during the last decades in Temuco, Chile. This study examined the contribution of socio-demographic factors, active family environment, and built environment factors to walking behavior and walking level based on three types of destination in Temuco. The results of Encuesta Origin Destino (EOD 2013), geographic information system (GIS), and, finally, hierarchical multiple regression analysis were used to examine the objectives. Correlations were found between total walking behavior, walking level based on three destination types, and several socio-demographic factors such as age, gender, and access to TV and Internet. Furthermore, correlations were found between walking behavior and active family environment, as well as several built environment factors. For instance, the higher mixed land use as well as number of parks and plazas contribute towards more overall walking as well as two types of walking. Identifying that most persons who walk come from low-income families and the negative impact of network connectivity on overall walking are the major differences between this context and developed countries.

Destinations fostering older adults' walking for transport: a cross-sectional study from Germany

Background

Having destinations within walking distance can encourage older people to walk. Yet, not all destinations may be equally important. Little is known about the types of destinations fostering older adults’ walking for transport in small and medium-sized towns and rural communities. The aim of this study was to explore the associations between the availability of different destinations and walking for transport among older adults living in communities with less than 100,000 inhabitants.

Methods

Between May and September 2019, self-reported data from 2242 older adults (≥ 65 years) living in the Metropolitan Region Northwest (Germany) were collected within the project AFOOT – Securing urban mobility of an aging population. Data from 2137 study participants were eligible for this analysis. Logistic regression models were used to investigate the relationship between the perceived destination availability of 19 different destinations within a 20-min or 10-min walk from home, respectively, and the engagement in walking for transport. Crude and adjusted models were run separately for each destination and distance category. Exploratory subgroup analyses examined the associations between the availability of destinations within a 20-min walk from home and walking for transport stratified by gender, use of a walking aid, and car availability.

Results

The availability of each of the investigated destinations within a 20-min walk and of nearly all of these destinations within a 10-min walk from home was significantly positively associated with walking for transport in crude models. Most associations remained significant after adjustment for covariates. The strongest associations were found for the availability of small stores, pharmacy, and bakery. The availability of a bus stop showed the weakest associations and was not significantly associated with walking for transport after adjustment for covariates.

Conclusions

The provision of local amenities within walking distance may be a promising approach to foster older adults’ walking for transport in smaller communities with less than 100,000 inhabitants and to enable active and healthy aging in place. Further quantitative and qualitative research is needed to validate these findings and to better understand older adults’ walking behavior.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02896-w.

[Factors related to regional differences among home-visit rehabilitation users]

AIM

The present study investigated the relationship between the type of residential area and each factor of the International Classification of Functioning, Disability and Health (ICF) framework among elderly subjects receiving home-visit rehabilitation.

METHODS

This was a cross-sectional study conducted at two institutions. A total 84 participants (46 men and 38 women, age: 79.1±7.8 years old) who were receiving home-visit rehabilitation in urban and rural areas were examined. The parameters measured included the modified Gait Efficacy Scale (mGES), grip strength, 30-seconds chair stand test (CS-30), Functional Independence Measure (FIM), Life-Space Assessment (LSA), Frenchay Activities Index (FAI), Ikigai-9, and Home and Community Environment (HACE), which is based on the ICF concepts of health status, physical structure, physical and mental functions, activities, participation, personal factors, and environmental factors respectively; these points were evaluated by physical or occupational therapists. The health status was based on the diagnosis obtained from the clinical record.

RESULTS

Receiving home-visit rehabilitation in a rural area was significantly associated with the LSA (odds ratio [OR]=1.075, p=0.028), optimistic and positive feelings for life (OR=0.698, p=0.040), and community mobility scores (OR=5.755, p=0.001).

CONCLUSIONS

Environmental factors, activities, and personal factors differed depending on the region where the elderly subject received home-visit rehabilitation. Thus, intervention methods concerning home-visit rehabilitation may need to be adjusted according to the region where the patient lives.

Association Between Physical Function and Neighborhood Environment in Healthy, Older Adults: An Exploratory Study Using Regression Tree Analysis

The aim of this study was to perform an exploratory investigation of the individual characteristics of older adults that affect the relationships between physical function and neighborhood environment. A total of 624 community-dwelling older adults living independently, aged ≥65 years, participated in this cross-sectional study. Physical function was assessed by muscle strength (grip strength and knee extension strength) and physical performance (5-m walking time and Timed Up and Go Test). The neighborhood environment was assessed using the International Physical Activity Questionnaire Environmental Module. The individual characteristics that affect the association between both were analyzed using multiple regression analysis and Classification and Regression tree (CaRT) analysis. In both older men and women, multiple regression analysis showed that neighborhood environment was significantly associated with physical function. On the other hand, on CaRT analyses, older men ≤80 years of age without low back pain and depressive symptoms and perceived good access to recreational facilities had the shortest 5-m walking time. However, CaRT analyses found no relationship between physical function and neighborhood environment in older women. The relationships between physical function and neighborhood environment may be altered by sex, age, and physical and mental health conditions.

Assessing the Impact of a Hilly Environment on Depressive Symptoms among Community-Dwelling Older Adults in Japan: A Cross-Sectional Study

Although some neighborhood environmental factors have been found to affect depressive symptoms, few studies have focused on the impact of living in a hilly environment, i.e., land slope, on depressive symptoms among rural older adults. This cross-sectional study aimed to investigate whether a land slope is associated with depressive symptoms among older adults living in rural areas. Data were collected from 935 participants, aged 65 years and older, who lived in Shimane prefecture, Japan. Depressive symptoms were assessed using the Zung Self-Rating Depression Scale (SDS) and defined on the basis of an SDS score ≥ 40. Land slopes within a 400 m network buffer were assessed using geographic information systems. Odds ratios (ORs) with 95% confidence intervals (CIs) of depressive symptoms were estimated using logistic regression. A total of 215 (23.0%) participants reported depressive symptoms. The land slope was positively associated with depressive symptoms (OR = 1.04; 95% CI = 1.01-1.08) after adjusting for all confounders. In a rural setting, living in a hillier environment was associated with depressive symptoms among community-dwelling older adults in Japan.

Effect of Living Environment Factors on Quality of Life in Patients With Chronic Thromboembolic Pulmonary Hypertension After Completion of Balloon Pulmonary Angioplasty - A Cross-Sectional Study

Background: This study investigated factors related to quality of life (QoL) in patients with chronic thromboembolic pulmonary hypertension who completed balloon pulmonary angioplasty (BPA).

Methods and Results: Patient QoL and living environment after BPA were evaluated prospectively using the 5-level EQ-5D questionnaire and International Physical Activity Questionnaire Environmental Module (IPAQ-E), respectively. Patients were mailed copies of both surveys. In addition, we reviewed patient charts and collected retrospective clinical data. Relationship between the clinical data and QoL and environmental living factors were investigated. Of the 33 subjects mailed the surveys, sufficient responses were obtained from 22 (71%). Spearman’s rank correlation coefficient showed that psychiatric disorders (r=−0.6865, P<0.01) and IPAQ-E Question 5 (r=0.5192, P=0.02), Question 6 (r=0.5265, P=0.02), and Question 13 (r=0.4552, P=0.04) were significantly correlated with EQ-5D scores after BPA.

Conclusions: A living environment that was difficult to walk around was associated with a worse QoL. A multidisciplinary approach will be required to improve QoL even after completion of BPA treatment.

Everyday Walking Among Older Adults and the Neighborhood Built Environment: A Comparison Between Two Cities in North America

A walkable neighborhood becomes particularly important for older adults for whom physical activity and active transportation are critical for healthy aging-in-place. For many older adults, regular walking takes place in the neighborhood and is the primary mode of mobility. This study took place in eight neighborhoods in Metro Portland (USA) and Metro Vancouver (Canada), examining older adults' walking behavior and neighborhood built environmental features. Older adults reported walking for recreation and transport in a cross-sectional telephone survey. Information on physical activity was combined with audits of 355 street segments using the Senior Walking Environmental Audit Tool-Revised (SWEAT-R). Multi-level regression models examined the relationship between built environmental characteristics and walking for transport or recreation. Older adults [N = 434, mean age: 71.6 (SD = 8.1)] walked more for transport in high-density neighborhoods and in Metro Vancouver compared to Metro Portland (M = 12.8 vs. M = 2.2 min/day; p < 0.001). No relationship was found between population density and walking for recreation. Older adults spent more time walking for transport if pedestrian crossing were present (p = 0.037) and if parks or outdoor fitness amenities were available (p = 0.022). The immediate neighborhood built environment supports walking for transport in older adults. Comparing two similar metropolitan areas highlighted that high population density is necessary, yet not a sufficient condition for walking in the neighborhood.

Walking for Transport among Older Adults: A Cross-Sectional Study on the Role of the Built Environment in Less Densely Populated Areas in Northern Germany

In the last decades, there has been rising interest in public health research in the importance of the built environment for a healthy and active life in old age, but little attention has been paid to less densely populated areas. This study aimed to explore the impact of the built environment on walking for transport in the context of an older population living in communities of <100,000 inhabitants. Within the project AFOOT–Securing urban mobility of an aging population, a cross-sectional postal survey was carried out from May to September 2019 in older adults (≥65 years) in the Metropolitan Region Northwest, Germany. Self-reported data from 2189 study participants were analyzed. Logistic and linear regression models were used to examine the associations between the built environment and walking for transport. Any walking and frequent walking were positively associated with nearly all built environment attributes, even after adjustment for demographic and health covariates. The amount of walking in minutes per week was associated only with residential density. Moderating effects of gender, age, and use of walking aids were identified. Improving the built environment appears to be a promising opportunity to motivate and enable older adults to walk for transport.

Walking toward Metro Stations: the Contribution of Distance, Attitudes, and Perceived Built Environment

Walking as an active means of travel is important as a sustainable mode of transport. Moreover, the level of walking in the surrounding areas of metro stations would contribute to maintaining the minimum rate of physical activity and, therefore, inhabitants’ general health. This study examined the impacts of walking attitude, walking distance, and perceived built environment on walking behavior for reaching the metro stations in Shiraz, Iran. Three metro stations were selected and a quantitative approach was used to examine the objectives. It was found that the average walking distance is less than the average in developed countries, such as the United States. People walked more when there was a shorter distance between their starting points and the metro stations. The contribution of walking attitudes and several built environment attributes to walking behavior was demonstrated. Finding the contribution of aesthetic attributes, such as accessibility to parks and housing types of the starting points of the walking trips, to walking for transport are taken into account as the novelties of this study. Policy makers of this city may apply the findings of this study—especially around the metro stations—to improve the average walking distance as well as walking behavior.

Older Adults' Daily Step Counts and Time in Sedentary Behavior and Different Intensities of Physical Activity

Background

Daily step count is the simplest measure of physical activity. However, little is known about how daily step count related to time spent in different intensities of physical activity (PA) and sedentary behavior (SB).

Methods

These cross-sectional data were derived from 450 older Japanese adults (56.7% men; mean age, 74.3 years) who were randomly selected from three communities and responded a survey. Daily step count and time spent in moderate-to-vigorous PA (MVPA), light-intensity PA (LPA), and SB were measured using a validated wearable technology (HJA-350IT). Associations of daily step count with time spent in measured behaviors were examined using linear regression models with isometric log-ratio transformations of time-use composition, adjusting for gender, age, and residential area.

Results

Participants averaged 5,412 (standard deviation, 2,878) steps/d and accumulated MVPA, LPA, and SB corresponding to 4.0%, 34.8%, and 61.2% of daily waking time, respectively. Daily step count significantly increased with increase in time spent in MVPA relative to other behaviors (ie, LPA and SB) and in the ratio of LPA to SB after allowing for MVPA. After stratification, daily step count was significantly related to the ratio of LPA to SB in those taking <5,000 steps/d, but not in those taking 5,000–7,499 and ≥7,500 steps/d.

Conclusions

Higher daily step count can be an indicator of not only larger relative contribution of time spent in MVPA, but also higher ratio between LPA and SB, particularly among those who are the least physically active.

Service Quality for Sports and Active Aging in Japanese Community Sports Clubs

(1) Background: This study aims to examine the association between service quality for sports and active aging and the impacts on different age cohorts; (2) Methods: This cross-sectional study used a convenience sample of 545 Japanese community sports club (CSC) members over 60 years old, recruited from across eight CSCs in Japan between 2012-2013. A self-administered questionnaire was used to measure the self-reported health status of the elderly, evaluations to CSCs, demographic characteristics, and information on sports programs; (3) Results: The results of multiple logistic regression showed that domains of general evaluation for sports (OR = 1.942 and 95% CI 1.336~2.824), benefits of sports (OR = 1.659 and 95% CI 1.344~2.047), and management in sports (OR = 1.273 and 95% CI 1.011~1.603) were important for club members aged 60-64, the young-old, and the old-old, respectively. With a reduced model for elderly members, stratified analyses showed a significant impact of service quality for sports on active aged people in the benefits and management domains, regardless of sociodemographic information or club participation behavior; (4) Conclusions: The findings suggest that the services encountered in sports are key to promoting health in a community. Service quality in age segmentation should be considered to promote and manage active aging in the future.

Associations Between Built Environment Characteristics and Walking in Older Adults in a High-Density City: A Study From a Chinese Megacity

The built environment is an important factor affecting physical activity, especially walkability. Walkability is used to characterize the user friendliness of outdoor physical activity. However, studies on walkability and physical activity are mainly concentrated on low-density Western cities. Study on the walkability of high-density cities in Asia, especially with the elderly, is seriously lacking. And walkability is often used as a composite indicator. This study mainly re-examines the relationship between the common indicators of walkability (population density, street connectivity, land-use mix, and retail density), transport-related walking, and leisure-time walking with older adults in China's megacities. Twelve housing estates in Wuhan were selected for study areas. We explored the association between the walking activities of 1,161 elderly people (≥60 years old) and the indicators of walkability in their neighborhoods. Socio-demographic characteristics were controlled in the multilevel logistic regression models of the built environment walking associations. We found that there was no significant correlation between the four indicators of walkability and transport-related walking. Street connectivity is significantly positively correlated with the participants' leisure-time walking (OR = 1.499, 95% CI = 1.068~2.103), and there was no significant correlation between the other indicator of walkability and leisure-time walking. The results show that there was no statistical correlation between walkability and transport-related walking in the elderly, and only one indicator was related to leisure-time walking. It is extremely important to re-examine the characteristics of built environments and elderly walking activities in high-density cities. Only by implementing effective intervention strategies in different urban backgrounds can cities move toward a more active and healthier path.

Positive Association of Physical Activity with Both Objective and Perceived Measures of the Neighborhood Environment among Older Adults: The Aichi Workers' Cohort Study

We examined the association between objective and perceived neighborhood characteristics and self-reported leisure-time physical activity (PA) in older Japanese residents living in areas ranging from metropolitan to rural in 2016. Objective measures used were walkability and the numbers of parks/green spaces and sports facilities within 500 or 1000 m of subjects’ homes, calculated using geographic information systems. Subjective measures were the subjects’ perceptions of their neighborhoods, assessed using a structured questionnaire. All variables were divided into three groups, and the lowest tertile was used as the reference. We assessed the location and frequency of strolling or brisk walking, moderate-intensity PA, and vigorous-intensity PA (sports) using a self-reported questionnaire and defined as performing a certain type of PA 3–4 times/week as a habit. Living in a neighborhood in the highest tertile for walkability and number of parks/green spaces as well as perception of having good access to recreational facilities, observing others exercising and the presence of walkable sidewalks was associated with walking and sports habits (multivariable odds ratios (ORs): 1.33–2.46, all p < 0.05). Interestingly, objective measures of PA-friendly environmental features were inversely associated with moderate-intensity PA habits, potentially because moderate-intensity PA consisted predominantly of gardening. In conclusion, living in an environment supportive of PA, whether objectively or subjectively measured, is related to leisure-time PA habits among older Japanese adults.

Objective scoring of streetscape walkability related to leisure walking: Statistical modeling approach with semantic segmentation of Google Street View images

Although the pedestrian-friendly qualities of streetscapes promote walking, quantitative understanding of streetscape functionality remains insufficient. This study proposed a novel automated method to assess streetscape walkability (SW) using semantic segmentation and statistical modeling on Google Street View images. Using compositions of segmented streetscape elements, such as buildings and street trees, a regression-style model was built to predict SW, scored using a human-based auditing method. Older female active leisure walkers living in Bunkyo Ward, Tokyo, are associated with SW scores estimated by the model (OR = 3.783; 95% CI = 1.459 to 10.409), but male walkers are not.

Location Choice in the Context of Older Adults' Leisure-Time Walking

Leisure-time walking is the most prevalent and preferred form of physical activity of older adults. In order to promote leisure-time walking and enhance the efficiency of using outdoor open spaces, the supply of different types of walking locations should match the needs, interests and preferences of older adults. However, there is limited knowledge on which location types are chosen by which groups of individuals under which conditions. This study therefore examines the effects of socio-demographics, episode participation attributes and neighborhood characteristics on the location choice of older adults for leisure-time walking. A multinomial logit model is estimated based on data collected among 316 respondents aged 60 or older in Dalian, China. The results indicate that older people’s location choices for walking are associated with their socio-demographics, episode participation attributes and neighborhood characteristics. Finally, implications of the results for the planning, design and management of open spaces are identified.

Five-year Changes in Methamphetamine Use, Dependence, and Remission in a Community-recruited Cohort

OBJECTIVES

Investigate patterns of methamphetamine use over time, specifically factors associated with remission from dependent and harmful patterns of use; and examine drug treatment and health/support service utilization pathways among people who use methamphetamine.

METHODS

People who regularly use methamphetamine were recruited from nontreatment settings in Melbourne, Australia, in 2010, and followed up twice over 5 years. Trajectories of past-month methamphetamine use and methamphetamine dependence were mapped. Random-effects logistic regression modeling identified factors associated with these outcomes.

RESULTS

Overall, past-month methamphetamine use and methamphetamine dependence decreased among the cohort over the study period. Variability in methamphetamine use and dependence trajectories was observed; 56% of participants achieved past-month abstinence; however, 14% subsequently relapsed and 44% reported past-month use at every time-point. During the study period, 27% of participants were never classified methamphetamine-dependent, 30% remitted from dependence, and 23% were consistently classified dependent. Factors independently associated with past-month methamphetamine use included male sex and poor physical health. Factors independently associated with methamphetamine dependence included poor physical health, low self-perceived social support, current mental health medication prescription, and current engagement with drug treatment services for methamphetamine use. Engagement with treatment and health/support services remained low (12%-22%) over the study period.

CONCLUSIONS

Our findings indicate people who remit from methamphetamine dependence, reduce their frequency of use or cease entirely can maintain this over long periods. Initiatives addressing social determinants of health could be optimal for combating methamphetamine dependence. Community-based frontline service providers should be educated in relation to appropriately addressing methamphetamine use.

Hilly environment and physical activity among community-dwelling older adults in Japan: a cross-sectional study

OBJECTIVES

We investigated whether a moderate-to-vigorous physical activity (MVPA) level and walking time were associated with a hilly environment in rural Japanese older adults.

DESIGN

Cross-sectional study.

SETTING

Unnan city, Ohnan and Okinoshima towns in Shimane, Japan.

PARTICIPANTS

Data were collected from 1115 adults from the Shimane CoHRE study, who were aged 60 years and older and living in rural Japan in 2012.

MEASURES

We measured the total time spent on MVPA and walking using a Japanese short version of the International Physical Activity Questionnaire. The land slope in 400 or 800 m network buffers was assessed using the geographic information system. A multivariable Poisson regression model examined the prevalence ratios (PR) and 95% CIs of walking time or MVPA levels meeting the WHO guideline (>150 min/week) in the land slope categories (low, middle and high), adjusted for confounders.

RESULTS

Engaging in the recommended level of MVPA was significantly associated with middle land slope (PR=1.07; p=0.03) and high land slope (PR=1.06; p=0.07) compared with low land slope in the 400 m network buffer, as well as with middle land slope (PR=1.02; p=0.48) and high land slope (PR=1.04; p=0.25) compared with the low land slope in the 800 m network buffer. Walking time was significantly associated with middle land slope (PR=1.13; p=0.04) and high land slope (PR=1.17; p=0.01) compared with low land slope in the 400 m network buffer, and with middle land slope (PR=1.09; p=0.16) and high land slope (PR=1.17; p<0.01) compared with low land slope in the 800 m network buffer. The sensitivity analysis found only a positive association between walking time and land slope in the 400 and 800 m network buffers.

CONCLUSIONS

This study showed that a hilly environment was positively associated with walking time among older adults living in rural Japan.

Physical Activity in the Summer Heat: How Hot Weather Moderates the Relationship Between Built Environment Features and Outdoor Physical Activity of Adults

BACKGROUND

Research has not yet examined how hot weather moderates the relationship between the built environment and outdoor physical activity levels. The authors posited that hot days will increase the magnitude of the expected directional effect of built environment features on physical activity.

METHODS

This longitudinal study included 134 US adults from the Three city Heat and Electrical failure AdapTation study. Adults self-reported physical activity for multiple summer days (nstudy-days = 742) in 2016. Hot days were defined as ≥90th percentile of daily maximum heat index. Built environment features included density, safety, trees, hilliness, connectivity, access to parks, and access to shops + services. Separate growth curve models with interaction terms (ie, hot day × built environment feature) were run for daily minutes of outdoor physical activity (ie, any activity and recommended activity).

RESULTS

Neither hot days nor built environment features impacted outdoor physical activity significantly, and hot days did not moderate the relationship between built environment features and physical activity (P > .05).

CONCLUSIONS

With adults failing to modify behavior on hot days, cities may be placing adults at increased risk of exertional heat illness. The authors recommend incorporating the risk of exertional heat illness in health impact assessments and deploying heat management strategies.

The neighborhood social environment and physical activity: a systematic scoping review

BACKGROUND

Investigating the association of the neighborhood social environment on physical activity is complex. A systematic scoping review was performed to (1) provide an inventory of studies assessing the influence of the neighborhood social environment on physical activity since 2006; (2) describe methodologies employed; and (3) formulate recommendations for the field.

METHODS

Two databases were searched using terms related to 'physical activity,' 'neighborhood,' and 'social environment' in January 2017. Eligibility criteria included: 1) physical activity as an outcome; 2) neighborhood social environment as a predictor; 3) healthy population (without diagnosed clinical condition or special population); 4) observational or experimental design. Of 1352 studies identified, 181 were included. Textual data relevant to the social environment measurement and analysis were extracted from each article into qualitative software (MAXQDA) and coded to identify social environmental constructs, measurement methods, level of measurement (individual vs. aggregated to neighborhood), and whether authors explicitly recognized the construct as the social environment. The following measures were generated for each construct: number of unique measurements; % of times measured at an aggregate level; % of times authors referred to the construct as the social environment. Social environmental constructs were then grouped into larger descriptive dimensions.

RESULTS/FINDINGS

Fifty-nine social environmental constructs were identified and grouped into 9 dimensions: Crime & Safety (n = 133 studies; included in 73% of studies); Economic & Social Disadvantage (n = 55, 33%); Social Cohesion & Capital (n = 47, 26%); Social Relationships (n = 22, 12%); Social Environment (n = 16, 9%); Disorder & Incivilities (n = 15, 8%); Sense of Place/Belonging (n = 8, 4%); Discrimination/Segregation (n = 3, 2%); Civic Participation & Engagement (n = 2, 1%). Across all articles, the social environment was measured using 176 different methods, was measured at an aggregate-level 38% of the time, and referred to as the social environment 23% of the time.

CONCLUSIONS

Inconsistent terminology, definitions, and measurement of the social environment and the lack of explicit language identifying constructs as the social environment make it challenging to compare results across studies and draw conclusions. Improvements are needed to increase our understanding of social environmental correlates and/or determinants of physical activity and facilitate cross-disciplinary conversations necessary to effectively intervene to promote physical activity.

TRIAL REGISTRATION

PROSPERO CRD42017059580.

Association of Perceived Built Environment Attributes with Objectively Measured Physical Activity in Community-Dwelling Ambulatory Patients with Stroke

There is little evidence on how perceptions of the built environment may influence physical activity among post-stroke patients. This study aimed to explore the associations between perceived built environment attributes and objectively measured physical activity outcomes in community-dwelling ambulatory patients with stroke. This cross-sectional study recruited patients who could walk outside without assistance. We assessed both objectively measured physical activity outcomes such as number of steps and duration of moderate-to-vigorous physical activity (MVPA) with an accelerometer and the patients’ perceived surrounding built environment with the International Physical Activity Questionnaire Environmental Module. Sixty-one patients (67.0 years old) were included. The multiple linear regression analysis showed significant associations of the presence of sidewalks (β = 0.274, p = 0.016) and access to recreational facilities (β = 0.284, p = 0.010) with the number of steps taken (adjusted R² = 0.33). In contrast, no significant associations were found between perceived built environment attributes and MVPA. These findings may help to suggest an approach to promote appropriate physical activity in patients with stroke depending on their surrounding built environment.

Associations of neighborhood walkability with intensity- and bout-specific physical activity and sedentary behavior of older adults in Japan

AIM

We examined the relationships of objectively-measured walkability with accelerometer-measured activity patterns including bout-specific moderate-to-vigorous physical activity (MVPA), light-intensity physical activity (LPA) and sedentary behavior in older Japanese adults.

METHODS

This cross-sectional study included 450 men and women (mean age 74 years) who were randomly selected from a resident registry of each municipality (Bunkyo, Fuchu and Oyama city). Neighborhood walkability was assessed using geographic information system data and activity patterns by a validated accelerometer (Active style Pro HJA-350IT). MVPA was assessed as overall (all minutes), short-bout (<10 min) and long-bout (≥10 min). We used analysis of covariance to examine environmental relationships with the three MVPA measures, LPA and sedentary behavior by quartiles of walkability, adjusting for accelerometer wear time and sociodemographic, behavioral and health-related factors.

RESULTS

In total, 27% of participants achieved ≥150 min/week of long-bout MVPA. Walkability was not associated with overall MVPA (Q1 = 35.0, Q2 = 31.9, Q3 = 31.4, Q4 = 34.2 min/day) Older adults living in low-walkability areas significantly accumulated more short-bout MVPA (Q1 = 27.2, Q2 = 22.1, Q3 = 20.1, Q4 = 20.5 min/day) and LPA (Q1 = 346, Q2 = 311, Q3 = 289, Q4 = 284 min/day), but less sedentary behavior (Q1 = 479, Q2 = 520, Q3 = 544, Q4 = 544 min/day) than those living in high-walkability areas.

CONCLUSIONS

Those living in low-walkability areas accumulated more LPA and short-bout MVPA. These activities might be helpful targets for initiatives to promote physical activity among older adult residents of low-walkability areas. Geriatr Gerontol Int 2019; 19: 861-867.

Modal Shift from Cars and Promotion of Walking by Providing Pedometers in Yokohama City, Japan

Mobility management is a transportation policy aiming to change travel behavior from car use to sustainable transportation modes while increasing people’s physical activity. Providing pedometers and visualizing step counts, popular interventions in public health practice, may constitute a mobility management program. However, the ease of modal shifts and changeability of walking habits differ across neighborhood environments. Using questionnaire data from 2023 middle-aged and older participants from Yokohama, Japan, in May 2017, this study examined (1) the relationship between the physical and social environments of Yokohama Walking Point Program participants who volunteered to use free pedometers and their modal shifts from cars to walking and public transport, and (2) whether participants’ modal shifts were associated with increases in step counts. Multivariate categorical regression analyses identified the frequency of greetings and conversations with neighbors as well as health motivation as important explanatory variables in both analyses. Participants living in neighborhoods far from railway stations and in neighborhoods with a high bus stop density tended to shift to walking and public transport, a modal shift that was highly associated with increased step counts. These results suggest that mobility management should be promoted in collaboration with public health and city planning professionals.

Environmental Factors Associated with Older Adult’s Walking Behaviors: A Systematic Review of Quantitative Studies

The aim of this study is to systematically review the relationship between neighborhood environments and all types of walking behaviors among older adults. Seventy peer-reviewed journal articles which met the selection criteria were examined. Research designs were summarized by geographical location and the associations of environmental characteristics and walking were calculated. Interactions between moderators and environmental characteristics for all types of walking were also categorized. Results have shown that transport walking is the most supported by neighborhood environmental characteristics. The positively related environmental characteristics are walkability, urbanization, land use mix-diversity and accessibility, walking amenities, and bicycle lanes. Total walking was positively associated with walkability and urbanization. Recreational walking was associated with neighborhood employment/income level, nearness to public transport/bus stops, and social cohesion. The most commonly used moderators were age and gender, but inconsistent moderating effects between neighborhood environments and walking were also found. In densely populated environments such as Hong Kong, older adults walked mostly for both transport and recreation. In contrast, American older adults in low density areas walked less for transport and more for recreation. Findings support a strong relationship between neighborhood environments and older adults’ walking. Future research should focus on longitudinal studies and comparison studies by geographic location.

Do Differences in Social Environments Explain Gender Differences in Recreational Walking across Neighbourhoods?

Within a city, gender differences in walking for recreation (WfR) vary significantly across neighbourhoods, although the reasons remain unknown. This cross-sectional study investigated the contribution of the social environment (SE) to explaining such variation, using 2009 data from the How Areas in Brisbane Influence healTh and AcTivity (HABITAT) study, including 7866 residents aged 42–67 years within 200 neighbourhoods in Brisbane, Australia (72.6% response rate). The analytical sample comprised 200 neighbourhoods and 6643 participants (mean 33 per neighbourhood, range 8–99, 95% CI 30.6–35.8). Self-reported weekly minutes of WfR were categorised into 0 and 1–840 mins. The SE was conceptualised through neighbourhood-level perceptions of social cohesion, incivilities and safety from crime. Analyses included multilevel binomial logistic regression with gender as main predictor, adjusting for age, socioeconomic position, residential self-selection and neighbourhood disadvantage. On average, women walked more for recreation than men prior to adjustment for covariates. Gender differences in WfR varied significantly across neighbourhoods, and the magnitude of the variation for women was twice that of men. The SE did not explain neighbourhood differences in the gender–WfR relationship, nor the between-neighbourhood variation in WfR for men or women. Neighbourhood-level factors seem to influence the WfR of men and women differently, with women being more sensitive to their environment, although Brisbane’s SE did not seem such a factor.

Perception of parks and trails as mobility facilitators and transportation walking in older adults: a study using digital geographical maps

BACKGROUND

Transportation walking represents a promising target for physical activity promotion in older adults. Perceived characteristics of the neighbourhood physical environment may affect older adults' choice of transportation mode for a routine activity such as walking to the grocery store.

AIMS

To (1) evaluate associations between older adults' perception of parks and trails as outdoor mobility facilitators and transportation walking, specifically to the grocery store; and (2) explore whether the spatial relationship between people's home, perceived facilitator and store was relevant for their transportation choice.

METHODS

Cross-sectional data were collected in a subsample of the 'Life-space mobility in old age' cohort. Multivariable logistic regression analysis on the binary outcome 'transportation walking' (vs. 'motorized transportation') was used to evaluate the association with perceived mobility facilitators in the neighborhood; in step (1) without and in step (2) with taking spatial relationships into account.

RESULTS

Perceiving a park as facilitator increased the odds of walking (N = 179; Odds Ratio 9.89; 95% Confidence interval 3.11-31.50). Spatial relationships did not affect transportation choice. Reporting a trail as facilitator was not significantly associated with walking.

CONCLUSIONS

Our findings suggest that the perception of environmental characteristics in the neighbourhood has an influence on older people's transportation choices. Taking environmental measures or informing older adults on their options in the neighbourhood might be possible ways to increase older adults' transportation walking on a population level.

[Descriptive epidemiology of accelerometer-measured moderate to vigorous physical activity in Japanese older adults]

AIM

Most physical activity (PA) guidelines for health promotion recommend moderate to vigorous PA (MVPA) lasting at least 10 minutes (long-bout MVPA). However, recent studies have shown the beneficial effects of short-bout MVPA (intermittent and lasting <10 minutes). Therefore, we aimed to clarify the detailed patterns of MVPA of community-dwelling older adults using accelerometers.

METHODS

This is a cross-sectional descriptive study. Community-dwelling older Japanese adults (total: 1,210; 70-80 years of age) randomly selected from residential registries of 3 municipalities (Bunkyo, Fuchu, and Oyama) were asked to wear an accelerometer (HJA-350 IT; Omron Healthcare, Japan). MVPA was classified by bout length (1-4, 5-9, 10-19, 20-29, and > 30 minutes). The mean frequency and duration of MVPA by each bout length and the proportion of long-bout MVPA were described.

RESULTS

Valid data were obtained from 450 participants (men: 56.7%; mean age: 74 years). The mean±standard deviation of the frequency and duration of MVPA bouts were 21.8±14.6 times/day and 2.1±0.9 min, respectively. The total duration of MVPA was 46.5±33.0 min/day. Long-bout MVPA accounted for 26.9%±23.5% of daily MVPA, whereas MVPA of 1-4 minutes accounted for 43.4%.

CONCLUSIONS

Older adults performed about 45 minutes of MVPA a day, but most of this was short-bout MVPA, which is overlooked by current WHO PA guidelines. In particular, short-bout MVPA was frequent among older women and those living in rural areas.

Association between health behaviors and mood disorders among the elderly: a community-based cohort study

BACKGROUND

According to a WHO report, nearly 15% of adults aged 60 and over suffer from a mental disorder, constituting 6.6% of the total disability for this age group. Taipei City faces rapid transformation towards an aging society, with the proportion of elderly in the total population rising from 12% in 2008 to 16% in 2016. The aim of this study is to identify the prevalence of mental disorders among the elderly in Taipei City and to elucidate risk factors contributing to mental disorders.

METHODS

The elderly health examination database was obtained from the Department of Health, Taipei City government, from 2005 to 2012. A total of 86,061 people underwent publicly funded health examinations, with 348,067 visits. Each year, there are around 43,000 elderly persons in Taipei City using this service. We used a mental health questionnaire including five questions to estimated relative risks among potential risk factors with the generalized estimating equations (GEE) model to measure the mental health status of the elderly. Mood disorders were measured with the Brief Symptom Rating Scale (BSRS-5) questionnaire. Age, education level, gender, marital status, living alone, drinking milk, eating vegetables and fruits, long-term medication, smoking status, frequency of alcohol consumption, frequency of physical activity, BMI, and number of chronic diseases were included as covariates.

RESULTS

The results show that being male (odds ratio (OR) 0.57; 95% CI = 0.56, 0.59), higher education (OR 0.88; 95% CI = 0.82, 0.95), no long-term medication (OR 0.57; 95% CI = 0.56, 0.58), and exercising three or more times per week (OR 0.94; 95% CI = 0.91, 0.98) were all positively correlated with better emotional status. However, being divorced (OR = 1.22, 95% CI = 1.09, 1.36), not drinking milk (OR = 1.12, 95% CI = 1.09, 1.14), not eating enough vegetables and fruits every day (OR = 1.78, 95% CI = 1.73, 1.83), daily smoking (OR = 1.15, 95% CI = 1.01, 1.32), and having more chronic diseases (OR = 1.02, 95% CI = 1.01, 1.03) were all correlated with poor mental status among the elderly.

CONCLUSIONS

The findings of this research can both estimate the prevalence of mood disorders at the community level, and identify risk factors of mood disorders at the personal level.

Relationships Between Neighbourhood Physical Environmental Attributes and Older Adults' Leisure-Time Physical Activity: A Systematic Review and Meta-Analysis

BACKGROUND

Activity-friendly neighbourhood physical environments with access to recreational facilities are hypothesised to facilitate leisure-time physical activity (LTPA) among older adults (≥ 65 years old). The aim of the current study was to systematically review and quantitatively summarise study findings on the relationships between physical environmental attributes and LTPA among older adults.

METHODS

An extensive search of literature, including grey literature, yielded 72 articles eligible for inclusion. The reported associations between seven categories of environmental attributes and six LTPA outcomes were extracted, weighted by sample size and study quality, and quantitatively summarised. Reported moderating effects of individual and environmental characteristics and neighbourhood definition were also examined.

RESULTS

We observed positive associations for walkability (p = 0.01), land-use mix-access (p = 0.02) and aesthetically pleasing scenery (p < 0.001) with leisure-time walking. For leisure-time walking within the neighbourhood, evidence was found for positive associations with land-use mix-access (p = 0.03) and access to public transit (p = 0.05), and a negative association with barriers to walking/cycling (p = 0.03). Evidence for positive relationships between overall LTPA and access to recreational facilities (p = 0.01) and parks/open space (p = 0.04) was found. Several environmental attribute-LTPA outcome combinations were insufficiently studied to draw conclusions. No consistent moderating effects were observed for individual and environmental characteristics and neighbourhood definition.

CONCLUSIONS

The observed significant relationships can be used to inform policy makers and planners on how to (re-)design neighbourhoods that promote LTPA among older adults. Many environmental attribute-LTPA outcome relationships have been studied insufficiently and several methodological issues remain to be addressed.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO 2016:CRD42016051180.

A Meta-analysis of the Literature on the Association of the Social and Built Environment With Obesity: Identifying Factors in Need of More In-Depth Research

Objective:

This study aims to identify groups of the social and built environment factors that have been studied substantially along with factors that need further attention, to guide the research, designing, and planning of the social and built environment for reducing obesity prevalence.

Data Source:

A systematic search of literature was undertaken from PubMed, Google Scholar, and Web of Knowledge.

Study Inclusion and Exclusion Criteria:

Keyword combination of “built environment,” “social environment,” and “obesity” were used to expand the search scope. Exclusion criteria included (1) any article with less than 50 citations from 2005 to 2010, and those with less than 25 citations from 2011 to 2015. In this way we included the most prominent peer-reviewed studies published in recent years while excluding less influential publications; (2) any article published in a language other than English; (3) literature review articles; (4) any article studying health outcomes not obesity related. We included research on eating behaviors since the studies contributed profoundly to food environment research.

Data Synthesis:

A meta-analysis of 153 empirical studies, selected from 2005 to 2015 based on a series of criteria, was conducted using factor analysis. The exploratory factor analysis was undertaken to group the prevalence and use of the social and built environment factors associated with obesity.

Results:

The findings suggested that the research community has gained a substantial understanding of the D variables of the built environment, including density, diversity, design, distance to transit, and destination access. Factors concerning different age groups, minority populations, groups with low socioeconomic status, food environment, and street-level urban design features have been less examined.

Conclusions:

The findings are important to guide future research directions, giving more attention to the factors in need of more in-depth research.

Activity-Friendly Built Environments in a Super-Aged Society, Japan: Current Challenges and toward a Research Agenda

There is a growing recognition of the role of built environment attributes, such as streets, shops, greenways, parks, and public transportation stations, in supporting people’s active behaviors. In particular, surrounding built environments may have an important role in supporting healthy active aging. Nevertheless, little is known about how built environments may influence active lifestyles in “super-aged societies”. More robust evidence-based research is needed to identify how where people live influences their active behaviors, and how to build beneficial space in the context of super-aged societies. This evidence will also be informative for the broader international context, where having an aging society will be the inevitable future. This commentary sought to move this research agenda forward by identifying key research issues and challenges in examining the role of built environment attributes on active behaviors in Japan, which is experiencing the longest healthy life expectancy, but rapid “super-aging”, with the highest proportion of old adults among its population in the world.

Drivers Are More Physically Active Than Non-Drivers in Older Adults

Car use has been identified as sedentary behavior, although it may enhance mobility, particularly in the older population. This cross-sectional study aimed to compare the time spent in objectively determined sedentary behavior (SB) and physical activity (PA) between older drivers and non-drivers. Four hundred and fifty Japanese older adults (74.3 ± 2.9 years) who had valid accelerometer data were included. They were asked to respond to a questionnaire and wear an accelerometer (HJA-350IT, Omron Healthcare) on their waist for 7 consecutive days in 2015. To compare activity time between drivers and non-drivers, we calculated estimated means using analysis of covariance, adjusting for sociodemographic, physical, and psychological factors and accelerometer wear time. Compared to non-drivers, drivers engaged in more light-intensity PA (LPA) (drivers: 325.0 vs. non-drivers: 289.0 min/day) and moderate-to-vigorous PA (drivers: 37.5 vs. non-drivers: 30.0 min/day) and less SB (drivers: 493.4 vs. non-drivers: 535.9 min/day) (all p < 0.05). After stratification by age, sex, and residential area, larger effect of driving on PA time was found in older-older adults, in men, and in rural residents. Older drivers were found to be more physically active than non-drivers, suggesting more access to outdoor activities or expanding social network.

Comparison of Factors Associated with Fear of Falling between Older Adults with and without a Fall History

Background: Although fear of falling (FOF) has been studied since FOF has negative consequences for the elderly, there is limited information about the risk factors of FOF, including the environment. The purpose of this study was to describe individual and environmental factors of FOF between those with and without a fall history from an ecological aspect and to examine whether individual and environmental factors differently affect the FOF according to the state of fall history in community-dwelling older adults in Korea. Methods: Data from the 2014 Survey of Living Conditions and Welfare Needs of Korean Older Adults were used. Participants were 7730 older adults. Hierarchical logistic regression analysis was conducted to examine the predictors of FOF. Results: According to the ecological model, female and discomfort with the neighborhood environment were significantly associated with greater odds of reporting FOF in both older adults with fall history and those without. A significant interaction was not observed between any variable of FOF in participants with and without a fall history. Conclusions: An ecological model including individual and environmental factors should be considered when conducting research and designing programs and decision policies related to FOF for older adults with and without a history of falling.

The Relationship between Urbanization, the Built Environment, and Physical Activity among Older Adults in Taiwan

Urbanization and ageing are global phenomena and offer unique challenges in different countries. A supportive environment plays a critical role in addressing the issue of behavioral change and health promotion among older adults. Many studies in the U.S., EU, and Australia have considered promoting physical activity in the community based on ecological models, whereas very few Asian studies have examined the relationships among urbanization, the built environment and physical activity in elderly at the ecological level, especially from a multi-level perspective. Due to the prevalence of post-war baby boomers and a very low birth-rate, the older population (aged 65 years old and older) in Taiwan has increased rapidly since 2011 and has exceeded the younger generation (0⁻14 years old) in 2017. Hence, the purpose of this study was first to examine the degree of urbanization in townships and the status of related built environments in Taiwan and then to investigate whether the built environment is associated with recommended amounts of physical activity among older adults. Three national datasets and a multi-level design were used in this research. Data at the individual level was obtained from the 2009 National Health Interview Survey (NHIS) which was taken from June 2009 to February 2010. Ecological data was obtained from the 2006 National Land Use Investigation of the National Geographic Information System and the 2010 Population and Housing Census. The analyses included a descriptive analysis, a bivariate analysis, a multiple logistic regression, and a multi-level analysis, utilizing a mostly hierarchical linear model (HLM). The results showed a significant relationship between factors at the environmental levels and physical activity in older adults. Urbanization, the built environment, and the median income of townships were positively correlated to the physical activity of the older adults. After controlling for individual-level factors, urbanization still exhibited this correlation. Parks and green spaces were associated with achieving the recommended amount of physical activity. However, there was no relationship after controlling for factors at the individual level. Detailed discussions were provided.

Cross-Sectional Associations of Environmental Perception with Leisure-Time Physical Activity and Screen Time among Older Adults

This study investigated associations of perceived environmental factors with leisure-time physical activity (LTPA) and screen time (ST) among older adults. A cross-sectional study was conducted by administering computer-assisted telephone interviews to 1028 older Taiwanese adults in November 2016. Data on personal factors, perceived environmental factors, LTPA, and ST were included. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to examine associations of environmental perception with LTPA and ST by using logistic regression analyses. The results showed that after adjusting for potential confounders, older adults who perceived their neighborhood with good access to shops (AS) and to public transportation (AT) were more likely to have sufficient LTPA (AS: OR = 1.64, 95% CI: 1.16–2.32; AT: OR = 1.43; 95% CI, 1.00–2.03) and less likely to have excessive ST (AS: OR = 0.70; 95% CI: 0.50–0.97; AT: OR = 0.64; 95% CI: 0.46–0.90). Different perceived environmental factors were also associated with LTPA and ST, respectively. This study highlights environment perception as a crucial factor for LTPA and ST. These findings suggest that policy makers and physical activity intervention designers should develop both common and individual environmental strategies to improve and increase awareness of the neighborhood environment to promote LTPA and reduce ST among older adults.

Neighborhood environmental factors are related to health-enhancing physical activity and walking among community dwelling older adults in Nigeria

Introduction: Health promotion strategies grounded by evidence-based determinants of physical activity constitute an important focus of physiotherapy practice in the twenty-first century. This study investigated associations between neighborhood environmental factors and health-related moderate-to-vigorous physical activity (MVPA) and walking for transportation and recreation among community dwelling Nigerian older adults. Methods: A representative sample of 353 Nigerian older adults (age = 68.9 ± 9.13 years) in a cross-sectional survey provided self-reported min/week of MVPA and walking for transportation and recreation and perceived neighborhood environmental factors. Results: In multilevel linear regression analyses, proximity of destinations (β = 3.291; CI = 0.392, 6.191), access to services and places (β = 4.417; CI = 0.995, 7.838), esthetics (β = 3.603; CI = 0.617, 6.590), traffic safety (β = 5.685; CI = 3.334, 8.036), and safety from crime (β = 1.717; CI = 0.466, 2.968) were related to more MVPA. Also, proximity of destinations (β = 1.656; CI = 0.022, 3.291) and safety from crime (β = 2.205; CI = 0.018, 4.579) were related to more transport walking. Access to services and places (β = 2.086; CI = 0.713, 3.459) and walking infrastructure and safety (β = 1.741; CI = 0.199, 3.282) were related to more recreational walking. Conclusions: Six of eight supportive environmental factors were associated with more physical activity among community dwelling older Nigerian adults. Policy makers including physiotherapists in this role can use the evidence to inform community-based physical activity and health promotion programs for older adults in Nigeria.

Associations of Older Taiwanese Adults' Personal Attributes and Perceptions of the Neighborhood Environment Concerning Walking for Recreation and Transportation

This study examines the cross-sectional associations between personal and perceived neighborhood environment attributes regarding walking for recreation and transportation among older Taiwanese adults. Data related to personal factors, perceived environmental factors, and time spent engaging in transportation-related and recreational walking were obtained from 1032 older adults aged 65 years and above. The data were analyzed by carrying out an adjusted binary logistic regression. After adjusting for potential confounders, two commonly perceived environmental factors, the presence of sidewalks (PS) and the presence of a destination (PD), were positively associated with 150 min of walking for recreation. Different personal and perceived environmental factors were associated with walking for recreation and transportation. These findings suggest that policy-makers and physical activity intervention designers should develop both common and individual environmental strategies in order to improve and increase awareness of the neighborhood environment to promote recreational and transportation walking behaviors among older adults.

Built environmental correlates of older adults' total physical activity and walking: a systematic review and meta-analysis

BACKGROUND

Identifying attributes of the built environment associated with health-enhancing levels of physical activity (PA) in older adults (≥65 years old) has the potential to inform interventions supporting healthy and active ageing. The aim of this study was to first systematically review and quantify findings on built environmental correlates of older adults' PA, and second, investigate differences by type of PA and environmental attribute measurement.

METHODS

One hundred articles from peer-reviewed and grey literature examining built environmental attributes related to total PA met inclusion criteria and relevant information was extracted. Findings were meta-analysed and weighted by article quality and sample size and then stratified by PA and environmental measurement method. Associations (p < .05) were found in relation to 26 individual built environmental attributes across six categories (walkability, residential density/urbanisation, street connectivity, access to/availability of destinations and services, infrastructure and streetscape, and safety) and total PA and walking specifically. Reported individual- and environmental-level moderators were also examined.

RESULTS

Positive environmental correlates of PA, ranked by strength of evidence, were: walkability (p < .001), safety from crime (p < .001), overall access to destinations and services (p < .001), recreational facilities (p < .001), parks/public open space (p = .002) and shops/commercial destinations (p = .006), greenery and aesthetically pleasing scenery (p = .004), walk-friendly infrastructure (p = .009), and access to public transport (p = .016). There were 26 individual differences in the number of significant associations when the type of PA and environmental measurement method was considered. No consistent moderating effects on the association between built environmental attributes and PA were found.

CONCLUSIONS

Safe, walkable, and aesthetically pleasing neighbourhoods, with access to overall and specific destinations and services positively influenced older adults' PA participation. However, when considering the environmental attributes that were sufficiently studied (i.e., in ≥5 separate findings), the strength of evidence of associations of specific categories of environment attributes with PA differed across PA and environmental measurement types. Future research should be mindful of these differences in findings and identify the underlying mechanisms. Higher quality research is also needed.

Built environmental correlates of older adults' total physical activity and walking: a systematic review and meta-analysis

BACKGROUND

Identifying attributes of the built environment associated with health-enhancing levels of physical activity (PA) in older adults (≥65 years old) has the potential to inform interventions supporting healthy and active ageing. The aim of this study was to first systematically review and quantify findings on built environmental correlates of older adults' PA, and second, investigate differences by type of PA and environmental attribute measurement.

METHODS

One hundred articles from peer-reviewed and grey literature examining built environmental attributes related to total PA met inclusion criteria and relevant information was extracted. Findings were meta-analysed and weighted by article quality and sample size and then stratified by PA and environmental measurement method. Associations (p < .05) were found in relation to 26 individual built environmental attributes across six categories (walkability, residential density/urbanisation, street connectivity, access to/availability of destinations and services, infrastructure and streetscape, and safety) and total PA and walking specifically. Reported individual- and environmental-level moderators were also examined.

RESULTS

Positive environmental correlates of PA, ranked by strength of evidence, were: walkability (p < .001), safety from crime (p < .001), overall access to destinations and services (p < .001), recreational facilities (p < .001), parks/public open space (p = .002) and shops/commercial destinations (p = .006), greenery and aesthetically pleasing scenery (p = .004), walk-friendly infrastructure (p = .009), and access to public transport (p = .016). There were 26 individual differences in the number of significant associations when the type of PA and environmental measurement method was considered. No consistent moderating effects on the association between built environmental attributes and PA were found.

CONCLUSIONS

Safe, walkable, and aesthetically pleasing neighbourhoods, with access to overall and specific destinations and services positively influenced older adults' PA participation. However, when considering the environmental attributes that were sufficiently studied (i.e., in ≥5 separate findings), the strength of evidence of associations of specific categories of environment attributes with PA differed across PA and environmental measurement types. Future research should be mindful of these differences in findings and identify the underlying mechanisms. Higher quality research is also needed.

Light and sporadic physical activity overlooked by current guidelines makes older women more active than older men

Background

Men are generally believed to be more physically active than women when evaluated using current physical activity (PA) guidelines, which count only moderate-to-vigorous physical activity (MVPA) in bouts lasting at least 10 min. However, it remains unclear men are truly more physically active provided that all-intensity PA are evaluated. This population based cross-sectional study aimed to examine gender differences in patterns of objectively-assessed PA in older adults.

Methods

One thousand two hundred ten community-dwelling Japanese older adults who were originally randomly selected from residential registry of three municipalities were asked to respond a questionnaire and wear an accelerometer (HJA-350IT, Omron Healthcare). The prevalence of achieving current PA guidelines, ≥150 min/week MVPA in bouts lasting at least 10 min, was calculated. Gender differences in volume of each-intensity activity (METs-hour) were assessed by analysis of covariance after adjustment for age and wear time.

Results

Data from 450 (255 men, mean 74 years) participants who had valid accelerometer data were analyzed. Women were less likely to meet the guidelines (men: 31.0, women: 21.5%; p < 0.05). However, women accumulated more light-intensity PA (LPA) and short-bout (1–9 min) MVPA, and thus established higher total volume of PA (men: 22.0 METs-hour/day, women: 23.9 METs-hour/day) (p < 0.05).

Conclusions

Older women were less active when evaluated against current PA guidelines, but more active by total PA. Considering accumulated evidence on health benefits of LPA and short-bout MVPA, our findings highlight the potential for the limitation of assessing PA using current PA guidelines.

Types of social participation and psychological distress in Japanese older adults: A five-year cohort study

Introduction

The most effective type of social participation against psychological distress in older adults is not well documented. The aim of this study was to examine whether different types of social participation are associated with changes in psychological distress level in older men and women in Japan.

Methods

Two thousand seven hundred community-dwelling older adults (aged 65–74 years, 50% women) were randomly selected from the resident registry of three cities. Of these, participants who reported social participation and psychological distress level in the baseline survey in 2010 were followed up. Psychological distress was evaluated based on K6 scales at baseline and follow-up (in 2015). Social participation level was examined using question items from the National Health and Nutrition Survey in Japan. Exploratory factor analysis was used to derive the underlying factor structure. Multiple linear regression analysis was used to examine the association between social participation and changes in psychological distress level after adjusting for covariates stratified by both gender and age group or living arrangement.

Results

Data from 825 community-dwelling older adults (45.3% women) were analyzed. Social participation was categorized into two types using factor analysis: community involvement (volunteer activities, community events, clubs for the elderly) and individual relationship (friendship, communication with family and friends, hobbies). During the 5-year follow-up, 29.5% of participants reported a deterioration in psychological distress. Higher community involvement was independently associated with lower risk of psychological distress for older women (β = 0.099, p = 0.047), whereas there were no associations with individual relationship for either gender. Furthermore, in older women living with others, higher community involvement was also associated with lower risk of psychological distress (β = 0.110, p = 0.048).

Conclusion

Community involvement provides older women with mental health benefits regardless of individual relationship level. Promoting community involvement may be an effective strategy for healthy mental aging.

Direct and Indirect Associations Between the Built Environment and Leisure and Utilitarian Walking in Older Women

BACKGROUND

The built environment predicts walking in older adults, but the degree to which associations between the objective built environment and walking for different purposes are mediated by environmental perceptions is unknown.

PURPOSE

We examined associations between the neighborhood built environment and leisure and utilitarian walking and mediation by the perceived environment among older women.

METHODS

Women (N = 2732, M age = 72.8 ± 6.8 years) from Massachusetts, Pennsylvania, and California completed a neighborhood built environment and walking survey. Objective population and intersection density and density of stores and services variables were created within residential buffers. Perceived built environment variables included measures of land use mix, street connectivity, infrastructure for walking, esthetics, traffic safety, and personal safety. Regression and bootstrapping were used to test associations and indirect effects.

RESULTS

Objective population, stores/services, and intersection density indirectly predicted leisure and utilitarian walking via perceived land use mix (odds ratios (ORs) = 1.01-1.08, 95 % bias corrected and accelerated confidence intervals do not include 1). Objective density of stores/services directly predicted ≥150 min utilitarian walking (OR = 1.11; 95% CI = 1.02, 1.22). Perceived land use mix (ORs = 1.16-1.44) and esthetics (ORs = 1.24-1.61) significantly predicted leisure and utilitarian walking, CONCLUSIONS: Perceived built environment mediated associations between objective built environment variables and walking for leisure and utilitarian purposes. Interventions for older adults should take into account how objective built environment characteristics may influence environmental perceptions and walking.

The neighbourhood physical environment and active travel in older adults: a systematic review and meta-analysis

BACKGROUND

Perceived and objectively-assessed aspects of the neighbourhood physical environment have been postulated to be key contributors to regular engagement in active travel (AT) in older adults. We systematically reviewed the literature on neighbourhood physical environmental correlates of AT in older adults and applied a novel meta-analytic approach to statistically quantify the strength of evidence for environment-AT associations.

METHODS

Forty two quantitative studies that estimated associations of aspects of the neighbourhood built environment with AT in older adults (aged ≥ 65 years) and met selection criteria were reviewed and meta-analysed. Findings were analysed according to five AT outcomes (total walking for transport, within-neighbourhood walking for transport, combined walking and cycling for transport, cycling for transport, and all AT outcomes combined) and seven categories of the neighbourhood physical environment (residential density/urbanisation, walkability, street connectivity, access to/availability of services/destinations, pedestrian and cycling infrastructure, aesthetics and cleanliness/order, and safety and traffic).

RESULTS

Most studies examined correlates of total walking for transport. A sufficient amount of evidence of positive associations with total walking for transport was found for residential density/urbanisation, walkability, street connectivity, overall access to destinations/services, land use mix, pedestrian-friendly features and access to several types of destinations. Littering/vandalism/decay was negatively related to total walking for transport. Limited evidence was available on correlates of cycling and combined walking and cycling for transport, while sufficient evidence emerged for a positive association of within-neighbourhood walking with pedestrian-friendly features and availability of benches/sitting facilities. Correlates of all AT combined mirrored those of walking for transport. Positive associations were also observed with food outlets, business/institutional/industrial destinations, availability of street lights, easy access to building entrance and human and motorised traffic volume. Several but inconsistent individual- and environmental-level moderators of associations were identified.

CONCLUSIONS

Results support strong links between the neighbourhood physical environment and older adults' AT. Future research should focus on the identification of types and mixes of destinations that support AT in older adults and how these interact with individual characteristics and other environmental factors. Future research should also aim to clarify dose-response relationships through multi-country investigations and data-pooling from diverse geographical regions.

The neighbourhood physical environment and active travel in older adults: a systematic review and meta-analysis

BACKGROUND

Perceived and objectively-assessed aspects of the neighbourhood physical environment have been postulated to be key contributors to regular engagement in active travel (AT) in older adults. We systematically reviewed the literature on neighbourhood physical environmental correlates of AT in older adults and applied a novel meta-analytic approach to statistically quantify the strength of evidence for environment-AT associations.

METHODS

Forty two quantitative studies that estimated associations of aspects of the neighbourhood built environment with AT in older adults (aged ≥ 65 years) and met selection criteria were reviewed and meta-analysed. Findings were analysed according to five AT outcomes (total walking for transport, within-neighbourhood walking for transport, combined walking and cycling for transport, cycling for transport, and all AT outcomes combined) and seven categories of the neighbourhood physical environment (residential density/urbanisation, walkability, street connectivity, access to/availability of services/destinations, pedestrian and cycling infrastructure, aesthetics and cleanliness/order, and safety and traffic).

RESULTS

Most studies examined correlates of total walking for transport. A sufficient amount of evidence of positive associations with total walking for transport was found for residential density/urbanisation, walkability, street connectivity, overall access to destinations/services, land use mix, pedestrian-friendly features and access to several types of destinations. Littering/vandalism/decay was negatively related to total walking for transport. Limited evidence was available on correlates of cycling and combined walking and cycling for transport, while sufficient evidence emerged for a positive association of within-neighbourhood walking with pedestrian-friendly features and availability of benches/sitting facilities. Correlates of all AT combined mirrored those of walking for transport. Positive associations were also observed with food outlets, business/institutional/industrial destinations, availability of street lights, easy access to building entrance and human and motorised traffic volume. Several but inconsistent individual- and environmental-level moderators of associations were identified.

CONCLUSIONS

Results support strong links between the neighbourhood physical environment and older adults' AT. Future research should focus on the identification of types and mixes of destinations that support AT in older adults and how these interact with individual characteristics and other environmental factors. Future research should also aim to clarify dose-response relationships through multi-country investigations and data-pooling from diverse geographical regions.

Associations of objectively-assessed neighborhood characteristics with older adults' total physical activity and sedentary time in an ultra-dense urban environment: Findings from the ALECS study

Associations of objectively-assessed neighborhood environment characteristics with accelerometer-based physical activity (PA) and sedentary time, and their socio-demographic and health-status moderators were examined. Data were collected on 402 Hong Kong Chinese older adults from neighborhoods stratified by socio-economic status and transport-related walkability. Few main effects were observed. Sex moderated a third of the associations of environmental attributes with light-to-vigorous PA and sedentary time. Education and car ownership also moderated several associations with moderate-to-vigorous PA, light-to-vigorous PA, and sedentary time. Only two associations depended on age and health-related status. These findings suggest that social factors rather than physical capacity and health status may need to be considered in efforts to optimize activity-friendly environments for Chinese older urban dwellers.