Physical activity in relation to urban environments in 14 cities worldwide: a cross-sectional study

Association between leisure-time physical activity and the built environment in China: Empirical evidence from an accelerometer and GPS-based fitness app

To reexamine the relationship between leisure-time physical activity (LTPA) and the built environment (BE), this paper takes advantage of the massive amount of data collected by an accelerometer and GPS-based fitness mobile app. Massive LTPA data from more than 3 million users were recorded by Codoon in 500m by 500m grid cells and aggregated to 742 natural cities in mainland China. Six BE indicators were quantified using GIS at the city scale. Robust regression analysis was used to estimate the correlation between LTPA and BE. Five of six BE indicators—connectivity, road density, land use mix, points of interest density, and density of parks and squares—were significantly, positively, independently, and linearly related to LTPA in the regression analysis. The study obtains findings that are consistent with the previous literature but also provides novel insights into the important role of POI density in encouraging LTPA, as well as how the relationship between LTPA and BE varies by time of day. The study also sheds light on the embrace of new technology and new data in public health and urban studies.

Do COVID19 infection rates change over time and space? Population density and socio-economic measures as regressors

The COVID19 pandemic motivated an interesting debate, which is related directly to core issues in urban economics, namely, the advantages and disadvantages of dense cities. On the one hand, compact areas facilitate more intensive human interaction and could lead to higher exposure to the infection, which make them the potential epicenter of the pandemic crisis. On the other hand, dense areas tend to provide superior health and educational systems, which are better prepared to handle pandemics, leading to higher recovery rates and lower mortality rates. The objective of the current study is to test the relationship between COVID19 infection rates (cases÷population) as the dependent variable, and two explanatory variables, population density and socio-economic measures, within two timeframes: May 11, 2020 and January 19, 2021. We use a different methodology to address the relationship between COVID19 spread and population density by fitting a parabolic, instead of a linear, model, while controlling socio-economic indices. We thus apply a better examination of the factors that shape the COVID19 spread across time and space by permitting a non-monotonic relationship. Israel provides an interesting case study based on a highly non-uniform distribution of urban population, and diversified populations. Results of the analyses demonstrate two patterns of change: 1) a significant rise in the median and average infection-population ratio for each level of population density; and 2) a moderate (a steep) rise in infection rates with increased population density on May 11, 2020 (January 19, 2021) for population densities of 4000 to 20,000 persons per square kilometer. The significant rise in the average and median infection-population ratios might be as attributed to the outcome of new COVID19 variants (i.e., the British and the South African mutants), which, in turn, intensify the virus spread. The steeper slope of infection rates and the rise in the standard deviation of the infection-population ratio may be explained by non-uniform spatial distribution of: dissemination of information in a variety of language; different levels of medical infrastructure in different parts of the country; varying levels of compliance to social distancing rules; and strict (limited) compliance to social distancing rules. The last factor of limited compliance might be the outcome of premature optimism due to extensive scope of the vaccination campaign in Israel, which is located in first place globally.

Can Obesity Prevalence Explain COVID-19 Indicators (Cases, Mortality, and Recovery)? A Comparative Study in OECD Countries

SARS-CoV-2 virus disease (COVID-19) is declared a global pandemic with multiple risk factors. Obesity is considered by several researchers as one of the serious risk factors for SARS-CoV-2 virus complications based on recent empirical studies. Yet, other scholars argue in favor of the existence of an obesity survival paradox and criticize the former group of studies on the grounds that they lack controls for race, socioeconomic status, or quality of care. The objective of the current study is to analyze the potential relationships between different SARS-CoV-2 virus indicators and obesity on a country-wide level based on an OECD report. In an attempt to test the counterintuitive possibility of an obesity survival paradox, the proposed empirical model relaxes the assumption of monotonic change by applying the quadratic design and testing which one of the two competing models (i.e., quadratic or linear) better fits the data. Findings suggest more complex relationships between SARS-CoV-2 virus indices and obesity rates than previously thought. Consequently, ethical guidelines referring to priority in intubation and intensive care treatments-published by the Israeli Ministry of Health in April 2020-should account for these complex relationships between obesity and SARS-CoV-2 virus. Indeed, there is a linear increase in mortality rate from SARS-CoV-2 virus with an elevated prevalence of obesity. Yet, other indicators, such as the number of infected per 10,00,000 persons, rates of severe SARS-CoV-2 virus cases, rates of recovered SARS-CoV-2 virus patients, and SARS-CoV-2 virus, as the cause of death exhibit quadratic, rather than linear, patterns. The reasons for these nonlinear patterns might be explained by several conditions such as increased metabolic reserves, more aggressive treatment, other non-SARS-CoV-2 virus complications for obese persons, and unidentified factors that should be examined in future research.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Nível de atividade física de adultos: associação com escolaridade, renda e distância dos espaços públicos abertos em Criciúma, Santa Catarina

RESUMO O objetivo do estudo foi avaliar a associação entre o nível de atividade física com a escolaridade e renda de adultos e distância dos espaços públicos abertos de Criciúma, Santa Catarina, Brasil. Aplicou-se um questionário para avaliar o perfil da população criciumense, e a avaliação dos espaços foi em in loco por meio do instrumento Physical Activity Resource Assessment – PARA. Identificou-se 100 espaços e entrevistou-se 820 residentes de ambos os sexos. Verificou-se que 74,9% da população não alcança a recomendação mínima de atividade física semanal. A variável escolaridade apresentou associação positiva com o nível de atividade física. Conclui-se que há necessidade de desenvolver estratégias que estimulem comportamentos ativos e reformulação de políticas públicas para utilização dos espaços públicos, promovendo uma cidade saudável.

Características percebidas da vizinhança e a prática de atividade física entre adolescentes e adultos jovens: um modelo com respostas distais

Os objetivos do estudo foram identificar perfis de vizinhança percebidos por adolescentes e adultos jovens, e estimar sua associação com a realização de atividade física global e de lazer. Utilizaram-se dados de 1.637 indivíduos entre 15 e 24 anos, de um estudo transversal, com amostragem por conglomerados, de uma cidade do Estado da Bahia, Brasil, em 2011. A atividade física foi mensurada pelo International Physical Activity Questionnaire (IPAQ), versão curta, além de questão sobre atividade no lazer. A percepção de características do ambiente físico e social da vizinhança se baseou em escala com 14 questões. Perfis de vizinhança foram definidos por meio de análise de classes latentes (LCA), e a estimação dos seus efeitos na atividade física usou o modelo com respostas distais. A análise de perfil latente resultou em três padrões de vizinhança, descritos como “urbana, sociável e favorável à atividade física - classe 1” (39,6%); “sociável e segura - classe 2” (24,4%); e “insegura, de baixa sociabilidade - classe 3” (36%). Os indivíduos pertencentes à “classe 1” apresentaram maior probabilidade de se exercitar (56,4%), enquanto, para as classes 2 e 3, estes percentuais corresponderam a 46,3% e 42,8%, respectivamente. Associação estatisticamente significante foi identificada apenas na classe “urbana, sociável e favorável à atividade física”, cuja chance de realizar atividade de lazer foi de 72% (OR = 1,72; IC95%: 1,29-2,29). Bairros com atributos favoráveis à prática de atividade física e a existência de elementos de urbanização aumentam a chance do comportamento ativo no lazer entre os adolescentes e adultos jovens. O uso de LCA e do modelo com repostas distais é promissor e inovador na abordagem sobre vizinhança.

How Europeans move: a moderate-to-vigorous physical activity and sitting time paradox in the European Union

OBJECTIVES

This study aimed to assess the interactions between physical activity (PA) and sedentary behaviour in a large population taking account of major sociodemographic characteristics.

STUDY DESIGN

Cross-sectional population-based study.

METHODS

Data from 28,031 individuals living in the European Union who were aged ≥15 years were retrieved from a cross-sectional survey, the Eurobarometer 2017. Interactions among the four mobility components (vigorous, moderate, walking activity and sitting time) were assessed at the individual level across age, gender and place of residence, and at the country level by compositional data analysis, hierarchical linear regressions and principal component analysis.

RESULTS

The most frequently reported PA was walking; however, sitting time represented >95% of the reported weekly times, whereas moderate-to-vigorous PA (MVPA) represented <1%. Women reported less PA and sitting time, age decreased total PA and increased sitting time, and individuals living in large urban areas reported lower PA and higher sitting times. MVPA decreased with age (β = -0.047, P < 0.001) and was lower in women (β = -0.760, P < 0.001) and those living in large urban areas (β = -0.581, P < 0.001), while walking and sitting times increased with age, being higher in women and lower in those living in rural areas. At the country level, sitting time was positively associated with moderate activity (β = 0.389, P = 0.041) and marginally non-significant with MVPA (β = 0.330, P = 0.087).

CONCLUSIONS

Walking was the highest contributor to weekly PA, whereas sitting time was paradoxically associated with higher MVPA. Specific measures to reduce sitting time are required to achieve an active lifestyle.

Associations between Park and Playground Availability and Proximity and Children's Physical Activity and Body Mass Index: The BEACH Study

A cross-sectional study was designed to evaluate the relationship between the availability and proximity to parks and playgrounds and physical activity (PA). Moreover, the accessibility to parks and playgrounds and its association with active commuting to/from school (ACS) and body mass index (BMI) were analyzed. The sample was composed of children aged 6-12 years old from the BEACH (Built Environment and Active CHildren) study in Valencia, Spain. The availability and proximity to parks and playgrounds were calculated at different buffer sizes (250, 500, 1000 and 1250 m) using geographical information system data. PA out of school was assessed using accelerometers. Sociodemographics and ACS were measured with a parent questionnaire. Objectively measured weight and height were used to calculate BMI. Mixed linear regression analyses were conducted for each exposure variable, adjusting for sociodemographics, neighborhood walkability level, and participant clustering. The number of parks and playgrounds were positively associated with moderate to vigorous PA (MVPA) and total PA (TPA); including light PA and MVPA, during weekdays, in different buffer sizes. A negative relationship between distance to the nearest playground and TPA during weekdays was found. In addition, the number of playgrounds was positively related to ACS in different buffer sizes, whereas park land area was negatively related to the BMI percentile. This study highlights the importance of assessing the availability and proximity to parks and playgrounds in children's neighborhoods when PA behavior and weight status are analyzed. Study findings may help policymakers when targeting interventions to promote health-enhancing behaviors in children.

Delineating the geographic context of physical activities: A systematic search and scoping review of the methodological approaches used in social ecological research over two decades

BACKGROUND

The social ecological approach suggests that the spatial context among other factors influence physical activity behavior. Ample research documents physical environmental effects on physical activity. Yet, to date inconsistent associations remain, which might be explained by conceptual and methodological challenges in measuring the spatial dimensions of health behavior. We review methods applied to measure the spatial contexts in the social ecological physical activity literature.

METHODS

Online databases and selected reviews were used to identify papers published between 1990 and 2020. A total of 2167 records were retrieved, from which 412 studies that used physical activity as a primary outcome variable, included measures of the physical environment and applied the main principles of the social ecological approach, were included.

RESULTS

Subjective approaches were the dominant method to capture the spatial context of physical activities. These approaches were applied in 67% (n=279) of the studies. From the objective approaches an administrative unit was most prevalent and was applied in 29% (n=118) of the studies. The most comprehensive objective spatial methods that capture the true environmental exposure, were used only in 2% (n=10) of the studies.

CONCLUSIONS

Current social ecological physical activity research applies simple conceptualizations and methods of the spatial context. While conceptual and methodological concerns have been repeatedly expressed, no substantive progress has been made in the use of spatial approaches. To further our understanding on place effects on health, future studies should carefully consider the choice of spatial approaches, and their effect on study results.

Parental-perceived home and neighborhood environmental correlates of accelerometer-measured physical activity among school-going children in Uganda

The benefits of physical activity (PA) on children's health and well-being are well established. However, many children do not meet the PA recommendations, increasing their risk of being overweight, obese, and non-communicable diseases. Environmental characteristics of homes and neighborhoods may constrain a child's ability to engage in PA, but evidence is needed to inform country-specific interventions in understudied low-income countries. This study assessed the associations between parental-perceived home and neighbourhood, built environment characteristics, and moderate-to-vigorous physical activity (MVPA) among children in Kampala city, Uganda. In this cross-sectional study, data were obtained from 256 children (55.5% girls) aged between 10 and 12 years and their parents. Children's MVPA was measured using waist-worn ActiGraph accelerometers. The environments were assessed using a valid self-reported parent survey. Linear regression models with standard errors (clusters) were used to analyze the relationship between environmental variables and children's MVPA. Sex-specific relationships were assessed using sex-stratified models. Play equipment at home (β = -2.37, p <0.001; unexpected direction), residential density (β = 2.70, p<0.05), and crime safety (β = -5.29, p <0.05; unexpected direction) were associated with children's MVPA. The sex-specific analyses revealed more inconsistent patterns of results with a higher perception of land use mix associated with less MVPA in girls (irrespective of school type attended), and higher perceptions of sidewalk infrastructure (β = -12.01, p <0.05) and walking and cycling infrastructure (β = -14.72, p <0.05) associated with less MVPA in girls attending public schools only. A better perception of crime safety was associated with less MVPA among boys and girls attending private schools (β = -3.80, p <0.05). Few environmental characteristics were related to children's MVPA in Uganda, and findings were largely inconsistent, especially among girls. Future studies are needed to understand the ecological determinants of health-related PA behaviors among children in Uganda.

Self-perceived health status among adults with obesity in Quebec: a cluster analysis

PURPOSE

People with obesity are a highly heterogeneous group. Characterizing this heterogeneity may help to improve public health by offering adapted interventions and treatments to more homogeneous sub-groups among obese patients. This research aims to (1) identify distinct clusters of people with obesity based on demographic, behavioural, and clinical factors in the province of Quebec (Canada) and (2) assess the association of these clusters with self-perceived health.

METHODS

We conducted a sex specific cluster analysis (multiple correspondence analysis and hierarchical clustering) of adults with body mass index (BMI) ≥ 30kg/m² from the 2015-2016 Canadian Community Health Survey in Quebec. Clusters were based on demographic, clinical, and behavioural characteristics. The clusters were tested for association with poor self-perceived health using logistic regression.

RESULTS

Three clusters of individuals with obesity were identified. These were (1) young individuals, (2) people with higher levels of depression and anxiety, and (3) older adults with high comorbidity. Those with high levels of depression and anxiety (9% of men versus 13% of women) were associated with the poorest self-perceived health.

CONCLUSION

People with obesity in Quebec can be categorized into three clusters based on demographic, clinical, and behavioural characteristics. The findings of this study draw attention to the need to examine the coexistence of obesity with depression and anxiety, particularly as it relates to self-perceived health.

Physical Activity in Polluted Air-Net Benefit or Harm to Cardiovascular Health? A Comprehensive Review

Both exposure to higher levels of polluted air and physical inactivity are crucial risk factors for the development and progression of major noncommunicable diseases and, in particular, of cardiovascular disease. In this context, the World Health Organization estimated 4.2 and 3.2 million global deaths per year in response to ambient air pollution and insufficient physical activity, respectively. While regular physical activity is well known to improve general health, it may also increase the uptake and deposit of air pollutants in the lungs/airways and circulation, due to increased breathing frequency and minute ventilation, thus increasing the risk of cardiovascular disease. Thus, determining the tradeoff between the health benefits of physical activity and the potential harmful effects of increased exposure to air pollution during physical activity has important public health consequences. In the present comprehensive review, we analyzed evidence from human and animal studies on the combined effects of physical activity and air pollution on cardiovascular and other health outcomes. We further report on pathophysiological mechanisms underlying air pollution exposure, as well as the protective effects of physical activity with a focus on oxidative stress and inflammation. Lastly, we provide mitigation strategies and practical recommendations for physical activity in areas with polluted air.

Association between built environment and physical activity in Latin American countries: a multicentre cross-sectional study

OBJECTIVE

To assess the association between the physical activity level and the built environment by accessibility, microinfrastructure and security in Latin America (LA).

DESIGN

We conducted a multicentre cross-sectional study to collect physical activity and built environment data. The levels of physical activity were calculated through the International Physical Activity Questionnaire survey. Using the Neighbourhood Environment Walkability Scale-Abbreviated, characteristics of the built environment were measured through three domains: accessibility, microinfrastructure and security. To estimate the association of the built environment and physical activity, we used mixed effects logistic regression analysis. In addition, likelihood ratio test to account for clustered effect within countries and/or cities was used.

SETTING

Eight countries in LA.

PARTICIPANTS

Adults aged 15-65 years (n=9218) living in urban areas and consented to participate of the Latin American Study of Nutrition and Health.

RESULTS

Most of the population in LA had access to a grocery store (97.2%), public transport stop (91.5%) and children's playground (81.6%). Metropolitan parks were more accessible in Ecuador (59.8%) and Colombia (59.2%) than in Venezuela (33.5%). Individuals located within 20 min of walking from sport facilities or children's playground areas were more likely to perform moderate-to-high physical activity OR 1.20 (95% CI 1.06 to 1.36) and OR 1.25 (95% CI 1.02 to 1.53), respectively. Only 14.5% of the population from the region considered that their neighbourhood had an adequate design for walking or cycling. Likewise, among adults living in LA, only 39.75% had the perception of living in a safe neighbourhood.

CONCLUSIONS

This multicentre study shows that currently, LA built environment does not promote physical activity in the region. Our findings provide the rationale to push forward, at regional and national levels, policies and interventions that will help to achieve a safe, healthy and friendly built environment to encourage participation in active recreation and sports in leisure time.

TRIAL REGISTRATION NUMBER

NCT02226627.

The Association Between Neighborhood Public Transportation Usage and Youth Physical Activity

INTRODUCTION

Routine adolescent physical activity is a well-established predictor of positive health across the lifespan, although wide disparities in youth physical activity engagement persist across sex and race/ethnicity. Transportation barriers may be related to adolescents' ability to access physical activity opportunities. This study examines the association between neighborhood public transportation usage and adolescent physical activity using a national sample.

METHODS

Cross-sectional data were drawn from the Family Life, Activity, Sun, Health, and Eating study (2014), a national sample of adolescents aged 12-17 years. Linear regression examined the association between neighborhood public transportation usage on the basis of neighborhood-level public transportation use and individual-level youth moderate-to-vigorous physical activity minutes per week. Models were developed for weekday, weekend, and combined moderate-to-vigorous physical activity for all youth and across sex and race/ethnicity subgroups. Analyses were run in 2020.

RESULTS

The final analytic data set included 1,247 adolescents aged 12-17 years (71% non-Hispanic White, 49% male, mean age=14.52 [SD=1.59] years). Adjusted models showed a stronger magnitude of association between high neighborhood public transportation usage and both weekday (β=8.79, 95% CI=1.00, 16.59) and combined (β=13.74, 95% CI=1.14, 26.35) moderate-to-vigorous physical activity than between low/moderate neighborhood public transportation usage and moderate-to-vigorous physical activity. The magnitude of the neighborhood public transportation usage-moderate-to-vigorous physical activity association was strongest among non-Hispanic Black and Hispanic adolescent girls.

CONCLUSIONS

This study found an association between neighborhood public transportation usage and adolescent moderate-to-vigorous physical activity, particularly among non-Hispanic Black and Hispanic adolescent girls. Findings from this research have the potential to inform targeted interventions for promoting adolescent physical activity to ultimately reduce chronic health disparities across the lifespan.

Liveable residential space, residential density, and hypertension in Hong Kong: A population-based cohort study

BACKGROUND

Hypertension is a leading preventable risk factor of chronic disease and all-cause mortality. Housing is a fundamental social determinant of health. Yet, little is known about the impacts of liveable residential space and density on hypertension.

METHODS AND FINDINGS

This retrospective observational study (median follow-up of 2.2 years) leveraged the FAMILY Cohort, a large territory-wide cohort in Hong Kong, Special Administrative Region, People's Republic of China to quantify associations of objectively measured liveable space and residential density with blood pressure outcomes among adults aged ≥16 years. Blood pressure outcomes comprised diastolic blood pressure (DBP), systolic blood pressure (SBP), mean arterial pressure (MAP), and hypertension. Liveable space was measured as residential floor area, and density was assessed using the number of residential units per building block and neighborhood residential unit density within predefined catchments. Multivariable regression models examined associations of liveable floor area and residential density with prevalent and incident hypertension. We investigated effect modifications by age, sex, income, employment status, and housing type. Propensity score matching was further employed to match a subset of participants who moved to smaller residences at follow-up with equivalent controls who did not move, and generalized linear models examined the impact of moving to smaller residences upon blood pressure outcomes. Our fully adjusted models of prevalent hypertension outcomes comprised 30,439 participants at baseline, while 13,895 participants were available for incident models at follow-up. We found that each interquartile range (IQR) increment in liveable floor area was associated with lower DBP (beta [β] = -0.269 mm Hg, 95% confidence interval [CI]: -0.419 to -0.118, p < 0.001), SBP (β = -0.317 mm Hg, -0.551 to -0.084, p = 0.008), MAP (β = -0.285 mm Hg, -0.451 to -0.119 with p < 0.001), and prevalent hypertension (odds ratio [OR] = 0.955, 0.918 to 0.993, p = 0.022) at baseline. Each IQR increment in residential units per building block was associated with higher DBP (β = 0.477 mm Hg, 0.212 to 0.742, p = <0.001), SBP (β = 0.750 mm Hg, 0.322 to 1.177, p = <0.001), MAP (β = 0.568 mm Hg, 0.269 to 0.866, p < 0.001), and prevalent hypertension (OR = 1.091, 1.024 to 1.162, p = 0.007). Each IQR increase in neighborhood residential density within 0.5-mi street catchment was associated with lower DBP (β = -0.289 mm Hg, -0.441 to -0.137, p = <0.001), SBP (β = -0.411 mm Hg, -0.655 to -0.168, p < 0.001), MAP (β = -0.330 mm Hg, -0.501 to -0.159, p = <0.001), and lower prevalent hypertension (OR = 0.933, 0.899 to 0.969, p < 0.001). In the longitudinal analyses, each IQR increment in liveable floor area was associated with lower DBP (β = -0.237 mm Hg, -0.431 to -0.043, p = 0.016), MAP (β = -0.244 mm Hg, -0.444 to -0.043, p = 0.017), and incident hypertension (adjusted OR = 0.909, 0.836 to 0.988, p = 0.025). The inverse associations between larger liveable area and blood pressure outcomes were more pronounced among women and those residing in public housing. In the propensity-matched analysis, participants moving to residences of lower liveable floor area were associated with higher odds of incident hypertension in reference to those who did not move (OR = 1.623, 1.173 to 2.199, p = 0.002). The major limitations of the study are unmeasured residual confounding and loss to follow-up.

CONCLUSIONS

We disentangled the association of micro-, meso-, and macrolevel residential densities with hypertension and found that higher liveable floor area and neighborhood scale residential density were associated with lower odds of hypertension. These findings suggest adequate housing in the form of provisioning of sufficient liveable space and optimizing residential density at the building block, and neighborhood levels should be investigated as a potential population-wide preventive strategy for lowering hypertension and associated chronic diseases.

Smart Watch Versus Classic Receivers: Static Validity of Three GPS Devices in Different Types of Built Environments

In order to study the relationship between human physical activity and the design of the built environment, it is important to measure the location of human movement accurately. In this study, we compared an inexpensive GPS receiver (Holux RCV-3000) and a frequently used Garmin Forerunner 35 smart watch, with a device that has been validated and recommended for physical activity research (Qstarz BT-Q1000XT). These instruments were placed on six geodetic points, which represented a range of different environments (e.g., residential, open space, park). The coordinates recorded by each device were compared with the known coordinates of the geodetic points. There were no differences in accuracy among the three devices when averaged across the six sites. However, the Garmin was more accurate in the city center and the Holux was more accurate in the park and housing estate areas compared to the other devices. We consider the location accuracy of the Holux and the Garmin to be comparable to that of the Qstarz. Therefore, we consider these devices to be suitable instruments for locating physical activity. Researchers must also consider other differences among these devices (such as battery life) when determining if they are suitable for their research studies.

Investigating the physical activity, health, wellbeing, social and environmental effects of a new urban greenway: a natural experiment (the PARC study)

BACKGROUND

Evidence for the health benefits of urban green space tends to stem from small, short-term quasi-experimental or cross-sectional observational research, whilst evidence from intervention studies is sparse. The development of an urban greenway (9 km running along 3 rivers) in Northern Ireland provided the opportunity to conduct a natural experiment. This study investigated the public health impact of the urban greenway on a range of physical activity, health, wellbeing, social, and perceptions of the environment outcomes.

METHODS

A repeated cross-sectional household survey of adult residents (aged ≥16 years) who lived ≤1-mile radius of the greenway (intervention sample) and > 1-mile radius of the greenway (control sample) was conducted pre (2010/2011) and 6-months post implementation (2016/2017). We assessed changes in outcomes pre- and post-intervention follow-up including physical activity behaviour (primary outcome measure: Global Physical Activity Questionnaire), quality of life, mental wellbeing, social capital and perceptions of the built environment. Linear regression was used to calculate the mean difference between post-intervention and baseline measures adjusting for age, season, education, car ownership and deprivation. Multi-level models were fitted using a random intercept at the super output area (smallest geographical unit) to account for clustering within areas. The analyses were stratified by distance from the greenway and deprivation. We assessed change in the social patterning of outcomes over time using an ordered logit to make model-based outcome predictions across strata.

RESULTS

The mean ages of intervention samples were 50.3 (SD 18.9) years at baseline (n = 1037) and 51.7 (SD 19.1) years at follow-up (n = 968). Post-intervention, 65% (adjusted OR 0.60, 95% CI 0.35 to 1.00) of residents who lived closest to the greenway (i.e., ≤400 m) and 60% (adjusted OR, 0.64 95% CI 0.41 to 0.99) who lived furthest from the greenway (i.e.,≥1200 m) met the physical activity guidelines - 68% of the intervention sample met the physical activity guidelines before the intervention. Residents in the most deprived quintiles had a similar reduction in physical activity behaviour as residents in less deprived quintiles. Quality of life at follow-up compared to baseline declined and this decline was significantly less than in the control area (adjusted differences in mean EQ5D: -11.0 (95% CI - 14.5 to - 7.4); - 30.5 (95% CI - 37.9 to - 23.2). Significant change in mental wellbeing was not observed despite improvements in some indicators of social capital. Positive perceptions of the local environment in relation to its attractiveness, traffic and safety increased.

CONCLUSIONS

Our findings illustrate the major challenge of evaluating complex urban interventions and the difficulty of capturing and measuring the network of potential variables that influence or hinder meaningful outcomes. The results indicate at this stage no intervention effect for improvements in population-level physical activity behaviour or mental wellbeing. However, they show some modest improvements for secondary outcomes including positive perceptions of the environment and social capital constructs. The public health impact of urban greenways may take a longer period of time to be realised and there is a need to improve evaluation methodology that captures the complex systems nature of urban regeneration.

Health-Enhancing Physical Activity in Europe-Combined Aerobic Physical Activity and Muscle-Strengthening Exercise Guideline Adherence Among 280,605 Adults From 28 European Countries

BACKGROUND

Compared with engaging in aerobic physical activity (aerobic PA; eg, walking, running, cycling) or muscle-strengthening exercise (MSE; eg, weight/resistance training) alone, epidemiological evidence suggests that combining both is linked to better health. However, the assessment of both PA modes is rare in health surveillance. This article provides the first multicountry study on the descriptive epidemiology of combined moderate to vigorous PA-MSE guideline adherence.

METHODS

Data were drawn from the European Health Interview Survey wave 2 (2013-2014), comprising samples from 28 European countries (n = 280,605). Self-reported aerobic PA and MSE were assessed using the validated European Health Interview Survey Physical Activity Questionnaire. The authors calculated the weighted proportions meeting the health-enhancing PA guideline (aerobic PA ≥ 150 min/wk and MSE ≥ 2 sessions/wk). Poisson regression assessed the prevalence ratios for meeting the combined guideline across sociodemographic factors and by country.

RESULTS

A total of 15.0% met the health-enhancing PA guideline. The lowest prevalence was from respondents from Southern and Central European countries (Romania, Poland, and Croatia, range: 0.5%-5.7%). Poorer self-rated health, older age, lower income, being female, and being obese had a lower likelihood of meeting the combined guideline.

CONCLUSIONS

Most European adults do not meet the health-enhancing PA guideline that includes both aerobic PA and MSE.

Built environment profiles for Latin American urban settings: The SALURBAL study

The built environment of cities is complex and influences social and environmental determinants of health. In this study we, 1) identified city profiles based on the built landscape and street design characteristics of cities in Latin America and 2) evaluated the associations of city profiles with social determinants of health and air pollution. Landscape and street design profiles of 370 cities were identified using finite mixture modeling. For landscape, we measured fragmentation, isolation, and shape. For street design, we measured street connectivity, street length, and directness. We fitted a two-level linear mixed model to assess the association of social and environmental determinants of health with the profiles. We identified four profiles for landscape and four for the street design domain. The most common landscape profile was the "proximate stones" characterized by moderate fragmentation, isolation and patch size, and irregular shape. The most common street design profile was the "semi-hyperbolic grid" characterized by moderate connectivity, street length, and directness. The "semi-hyperbolic grid", "spiderweb" and "hyperbolic grid" profiles were positively associated with higher access to piped water and less overcrowding. The "semi-hyperbolic grid" and "spiderweb" profiles were associated with higher air pollution. The "proximate stones" and "proximate inkblots" profiles were associated with higher congestion. In conclusion, there is substantial heterogeneity in the urban landscape and street design profiles of Latin American cities. While we did not find a specific built environment profile that was consistently associated with lower air pollution and better social conditions, the different configurations of the built environments of cities should be considered when planning healthy and sustainable cities in Latin America.

A Critique of National Physical Activity Policy in Oman Using 3 Established Policy Frameworks

BACKGROUND

This paper aimed to assess the development process, content, and early implementation of Oman's national physical activity plan of action to identify strengths and areas for improvement.

METHODS

Data were extracted from 4 documents: national noncommunicable diseases policy, physical activity plan of action, and 2 World Health Organization Mission Reports. Three policy frameworks and approaches (physical activity content analysis grid, health-enhancing physical activity policy audit tool, and policy cube approach for diet-related noncommunicable diseases) were used.

RESULTS

The findings demonstrated that policymakers engaged a broad range of sectors in developing a national plan. It aligned with many of the elements from the 3 policy frameworks (ie, multisectoral approach, political commitment/leadership, identification of national goals and targets, time frame for implementation). The main gaps included the lack of a specified sustainable funding mechanism, systems for monitoring progress, and an emphasis on general interventions, with limited focus on specific target groups.

CONCLUSION

A range of sectors were engaged in the development of Oman's national physical activity plan of action, with strong political commitment and using global guidance and local evidence. Establishing a strong accountability framework, including a clear financing mechanism, is critical for Oman to meet its target for a 10% relative reduction in physical inactivity by 2025.

The Effect of Commuting Time on Job Stress in Obese Men With Different Exercise Frequency in China

Previous studies have mainly focused on the independent impact of commuting time, exercise, and stress on people. There are few studies regarding the impact of the combined effect of multiple factors on special populations such as obese people. As obesity has become increasingly widespread in China, we studied the impact of commuting time on work stress on Chinese obese men (who exercise regularly vs. who exercise irregularly). We performed a secondary retrospective analysis of the cross-sectional data from the 2014 China Labor Force Dynamics Survey. We found that long commute times and less exercise have a positive effect on the increase in stress, but the effect is less evident for people who exercise regularly. Commuters traveling on foot are more stressed than those traveling by car. This study also found that commuting time had a significant impact on the perceived work stress of obese men who exercised irregularly. But the relationship between commuting time and work stress was different among groups with different commuting styles. For obese men who commuted on foot or motorcycle, commuting time had a significant impact on their job stress. However, for obese men who commuted by bicycle, bus, or car, commuting time had no significant effect on job stress. Additionally, active and passive commuting have different effects on stress. Active commuters tend to be more stressed, while passive commuters do not show a significant impact.

Aiming at Optimal Physical Activity for Longevity (OPAL)

Although even small volumes (15–20 min) of daily physical activity (PA) are associated with health benefits, the optimal volume for healthy aging and longevity is substantially larger, amounting to about 100 min of daily moderate PA. The accomplishment of this objective likely requires the development of an appropriate PA lifestyle at an early age. Research initiatives are necessary addressing the motivational contribution of families, school surroundings and sport clubs, perhaps combined with role model effects and instructions for the specific implementation. Such approaches would need an enlarged agreement in readdressing this new aim followed by the launch of a new research strategy in order to develop specific offers for the respective age cohorts.

Treating two pandemics for the price of one: Chronic and infectious disease impacts of the built and natural environment

Compact walkable environments with greenspace support physical activity and reduce the risk for depression and several obesity-related chronic diseases, including diabetes and heart disease. Recent evidence confirms that these chronic diseases increase the severity of COVID-19 infection and mortality risk. Conversely, denser transit supportive environments may increase risk of exposure to COVID-19 suggesting the potential for contrasting chronic versus infectious disease impacts of community design. A handful of recent studies have examined links between density and COVID-19 mortality rates reporting conflicting results. Population density has been used as a surrogate of urban form to capture the degree of walkability and public transit versus private vehicle travel demand. The current study employs a broader range of built environment features (density, design, and destination accessibility) and assesses how chronic disease mediates the relationship between built and natural environment and COVID-19 mortality. Negative and significant relationships are observed between built and natural environment features and COVID-19 mortality when accounting for the mediating effect of chronic disease. Findings underscore the importance of chronic disease when assessing relationships between COVID-19 mortality and community design. Based on a rigorous simulation-assisted random parameter path analysis framework, we further find that the relationships between COVID-19 mortality, obesity, and key correlates exhibit significant heterogeneity. Ignoring this heterogeneity in highly aggregate spatial data can lead to incorrect conclusions with regards to the relationship between built environment and COVID-19 transmission. Results presented here suggest that creating walkable environments with greenspace is associated with reduced risk of chronic disease and/or COVID-19 infection and mortality.

The Effect of High-Density Built Environments on Elderly Individuals' Physical Health: A Cross-Sectional Study in Guangzhou, China

The built environment refers to the objective material environment built by humans in cities for living and production activities. Existing studies have proven that the built environment plays a significant role in human health, but little attention is paid to the elderly in this regard. At the same time, existing studies are mainly concentrated in Western developed countries, and there are few empirical studies in developing countries such as China. Based on POI (point of interest) data and 882 questionnaires collected from 20 neighborhoods in Guangzhou, we employ multilevel linear regression modeling, mediating effect modeling, to explore the path and mechanism of the impact of the built environment on elderly individuals' physical health, especially the mediating effects of physical and social interaction activity. The results show that the number of POIs, the distance to the nearest park and square, and the number of parks and squares are significantly positively correlated with the physical health of the elderly, while the number of bus and subway stations and the distance to the nearest station are significantly negatively correlated. Secondly, physical activity and social networks play a separate role in mediating the effect of the built environment on elderly individuals' physical health. The results enrich the research on the built environment and elderly individuals' health in the context of high-density cities in China and provide some reference basis for actively promoting spatial intervention and cultivating a healthy aging society.

The Impact of Built and Social Environmental Characteristics on Diagnosed and Estimated Future Risk of Dementia

BACKGROUND

Dementia is a major global health challenge and the impact of built and social environments' characteristics on dementia risk have not yet been fully evaluated.

OBJECTIVE

To investigate associations between built and social environmental characteristics and diagnosed dementia cases and estimated dementia risk.

METHODS

We recruited 25,511 patients aged 65 and older from family physicians' practices. We calculated a dementia risk score based on risk and protective factors for patients not diagnosed with dementia. Our exposure variables were estimated for each statistical area level 1: social fragmentation, nitrogen dioxide, public open spaces, walkability, socio-economic status, and the length of main roads. We performed a multilevel mixed effect linear regression analysis to allow for the hierarchical nature of the data.

RESULTS

We found that a one standard deviation (1-SD) increase in NO2 and walkability score was associated with 10% higher odds of any versus no dementia (95% CI: 1%, 21% for NO2 and 0%, 22% for walkability score). For estimated future risk of dementia, a 1-SD increase in social fragmentation and NO2 was associated with a 1% increase in dementia risk (95% CI: 0, 1%). 1-SD increases in public open space and socioeconomic status were associated with 3% (95% CI: 0.95, 0.98) and 1% decreases (95% CI: 0.98, 0.99) in dementia risk, respectively. There was spatial heterogeneity in the pattern of diagnosed dementia and the estimated future risk of dementia.

CONCLUSION

Associations of neighborhood NO2 level, walkability, public open space, and social fragmentation with diagnosed dementia cases and estimated future risk of dementia were statistically significant, indicating the potential to reduce the risk through changes in built and social environments.

Understanding the impact of the installation of outdoor fitness equipment and a multi-sports court on park visitation and park-based physical activity: A natural experiment

INTRODUCTION

This natural experiment examined the impact of the installation of outdoor fitness equipment and one multi-sports court in a park located in Melbourne, Australia on park visitation and park-based physical activity compared to a control park. Barriers and facilitators to use of this equipment among adult park visitors were also explored.

METHODS

Park visitation and moderate-vigorous physical activity (MVPA) in the two parks were assessed before (T1, 2016) and after the intervention (T2, 2019) using observations of park visitors from children to older adults across four days (7.30am-5.00pm). The relative change in observed counts in visitors from T1-T2 in the intervention park compared to the control park was used to assess the effect of the park refurbishment. Intercept surveys regarding barriers and facilitators were conducted with adult park visitors.

RESULTS

Over the three-year period, total visitor counts increased by 16% and the number of park visitors observed engaging in MVPA increased by 24% in the intervention park. However, there were no significant intervention effects on total visitor counts (IRR = 0.89, 95%CI: 0.62, 1.30) or MVPA (IRR = 0.80, 95%CI: 0.53, 1.19) relative to the control park. Examples of frequently mentioned facilitators to increase use of the sports court and fitness equipment included having someone to use the facilities with and instructional signage, and common barriers included poor weather and lack of time.

CONCLUSIONS

The impact of the park upgrade on visitation and MVPA was not significant. A better understanding of the broader appeal of outdoor fitness equipment and a multi-sports court among different segments of the population is needed.

Social and Economic Differences in Neighborhood Walkability Across 500 U.S. Cities

INTRODUCTION

Neighborhood walkability has been established as a potentially important determinant of various health outcomes that are distributed inequitably by race/ethnicity and sociodemographic status. The objective of this study is to assess the differences in walkability across major urban centers in the U.S.

METHODS

City- and census tract-level differences in walkability were assessed in 2020 using the 2019 Walk Score across 500 large cities in the U.S.

RESULTS

At both geographic levels, high-income and majority White geographic units had the lowest walkability overall. Walkability was lower with increasing tertile of median income among majority White, Latinx, and Asian American and Native Hawaiian and Pacific Islander neighborhoods. However, this association was reversed within majority Black neighborhoods, where tracts in lower-income tertiles had the lowest walkability. Associations varied substantially by region, with the strongest differences observed for cities located in the South.

CONCLUSIONS

Differences in neighborhood walkability across 500 U.S. cities provide evidence that both geographic unit and region meaningfully influence associations between sociodemographic factors and walkability. Structural interventions to the built environment may improve equity in urban environments, particularly in lower-income majority Black neighborhoods.

Moderation effect of urban density on changes in physical activity during the coronavirus disease 2019 pandemic

Various social distancing measures were carried out in many cities worldwide during the coronavirus disease 2019 pandemic (COVID-19). These measures have led to decreased physical activity levels and higher health risks among urban populations. Strong evidence has been established that built environment characteristics can stimulate physical activity and thus improve public health during non-pandemic periods. Urban density was arguably one of the most important built environment characteristics. However, little is known about whether high urban density amplifies or attenuates the decline in physical activity during the pandemic. Based on two-wave physical activity data collected before and during the pandemic (in January and May 2020, respectively), we used moderation analysis to compare the changes in physical activity levels between people living in low- and high-density neighborhoods. Our results showed that people living in low-density areas have a smaller decrease in physical activity conducted in neighborhood, compared to those living in high-density areas. Our findings suggest that a flexible and porous urban development strategy could enhance the resilience of a city during the coronavirus pandemic and beyond.

Do population density, socio-economic ranking and Gini Index of cities influence infection rates from coronavirus? Israel as a case study

A prominent characteristic of the COVID-19 pandemic is the marked geographic variation in COVID-19 prevalence. The objective of the current study is to assess the influence of population density and socio-economic measures (socio-economic ranking and the Gini Index) across cities on coronavirus infection rates. Israel provides an interesting case study based on the highly non-uniform distribution of urban populations, the existence of one of the most densely populated cities in the world and diversified populations. Moreover, COVID19 challenges the consensus regarding compact planning design. Consequently, it is important to analyze the relationship between COVID19 spread and population density. The outcomes of our study show that ceteris paribus projected probabilities to be infected from coronavirus rise with population density from 1.6 to 2.72% up to a maximum of 5.17-5.238% for a population density of 20,282-20,542 persons per square kilometer (sq. km.). Above this benchmark, the anticipated infection rate drops up to 4.06-4.50%. Projected infection rates of 4.06-4.50% are equal in cities, towns and regional councils (Local Authorities) with the maximal population density of 26,510 and 11,979-13,343 persons per sq. km. A possible interpretation is that while denser cities facilitate human interactions, they also enable and promote improved health infrastructure. This, in turn, contributes to medical literacy, namely, elevated awareness to the benefits associated with compliance with hygienic practices (washing hands), social distancing rules and wearing masks. Findings may support compact planning design principles, namely, development of dense, mixed use, walkable and transit accessible community design in compact and polycentric regions. Indeed, city planners should weigh the costs and benefits of many risk factors, including the COVID19 pandemic.

Tunneling a crosstown highway: a natural experiment testing the longitudinal effect on physical activity and active transport

Background

In the city of Maastricht in the Netherlands, a highway crossing several deprived neighborhoods was tunneled in 2016. The vacant space on top of this tunnel was redesigned and prioritized for pedestrians and cyclists. The aim of this study was to evaluate the effect of this major infrastructural change, named the Green Carpet, on total and transport-based physical activity (PA) levels.

Methods

Participants (≥18 years) were part of one of three area-based exposure groups. The maximal exposure group lived in neighborhoods directly bordering the Green Carpet. The minimal exposure group consisted of individuals living at the other side of the city, and the no exposure group consisted of individuals living in a nearby city. Actual use of the new infrastructure was incorporated as a second measure of exposure. Data were collected before and 3-15 months after the opening of the Green Carpet. Device-based measurements were conducted to obtain PA levels and collect location data. Changes in PA over time and intervention effects were determined using linear mixed models.

Results

PA levels in the Green Carpet area increased for the maximal and minimal exposure groups, but did not lead to an increase in total or transport-based PA. For the no exposure group, transport-based MVPA decreased and transport-based SB increased. The significant interaction (time x exposure) for transport-based SB, indicated differences in trends between the no exposure and maximal exposure group (B=-3.59, 95% CI - 7.15; -0.02) and minimal exposure group (B= -4.02, 95% CI -7.85, -0.19). Trends in the results based on analyses focusing on actual use and non-use of the new infrastructure were similar to those of the area-based analyses.

Conclusions

Results suggest that the Green Carpet led to more PA in this specific area, but did not increase the total volume of PA. The area-based differences might reflect the differences between users and non-users, but we should be careful when interpreting these results, due to possible interference of selective mobility bias. This paper reflects that the relationship between infrastructure and PA is not unambiguous.

Trial registration

This research was retrospectively registered at the Netherlands Trial Register (NL8108).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01180-1.

Investigating the WHAT and WHY on older adults' use of neighborhood open spaces following an environmental intervention

Using neighborhood open spaces (NOS) may be an easy way for older adults to maintain healthy aging through physical activity and social interaction. Little is known about older adults' use of NOS, their preferences, and barriers to using them. This paper presents older adults' use of NOS in a deprived neighborhood before and after an intervention and factors promoting or inhibiting their use using convergent mixed methods design. Participatory research was employed involving older adults in the intervention. The System for Observing Play and Recreation in Communities was used to observe older adults' use of 13 NOS in spring 2017 (baseline) and spring 2018 (follow-up). Ten interviews were conducted in 2018 to identify barriers and facilitators for using NOS. Two NOS had a pavilion built and, in one NOS, benches were renovated, including building raised flower beds and small tables. At baseline, 209 older adults were observed, whereas 329 were observed at follow-up. More (44%) older adults were observed at follow-up in the NOS with the renovated benches. No use of the two pavilions was observed. The interviews identified six factors important for older adults' use of NOS: weather, support for social caretakers, support for resourceful volunteers, organized activities, social interaction, and sense of ownership. Organizational resources, such as social caretakers and volunteers, are important to promote older adults' use of NOS. Social interaction is a key factor for older adults' use of NOS and should be prioritized by health promoters.

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.

Park environment and moderate-to-vigorous physical activity in parks among adolescents in a high-density city: the moderating role of neighbourhood income

Background

Urban parks are critical environmental resources in which adolescents engage in physical activity (PA). Evidence on the associations between park environmental characteristics and park-based PA in adolescents is mixed, particularly for high-density cities. Evidence is also lacking concerning the moderating role of neighbourhood socioeconomic status on the park-PA relationships. The current study aimed to examine the associations between park environmental characteristics and moderate-to-vigorous physical activity (MVPA) in parks among adolescents in Hong Kong and the moderating effect of neighbourhood income on these associations.

Methods

A cross-sectional study involving direct observations of adolescents was conducted in 32 randomly selected urban parks in Hong Kong. Park environmental characteristics were measured using the Community Park Audit Tool. Park-based MVPA among adolescents was measured using the System for Observation Play and Recreation in Communities. Neighbourhood income was extracted from the 2011 Hong Kong Population Census data on median household income.

Results

There was a significant positive association between the quality of amenities and park-based MVPA (metabolic equivalents per observation) in adolescents. However, the associations between the diversity of active facilities, greenness and adolescents’ park-based MVPA were not significant. Neighbourhood income moderated the association between adolescents’ park-based MVPA and park safety, where the relationship between park safety and park-based MVPA was significantly positive in low-income neighbourhoods but not significant in high-income neighbourhoods. An income-by-environment interaction was also observed concerning park aesthetics, with a negative relationship between park aesthetics and park-based MVPA in high-income neighbourhoods but not in low-income neighbourhoods.

Conclusion

Our findings provide evidence regarding how park environment and neighbourhood income impact adolescents’ park-based MVPA in Hong Kong. These findings can inform urban planning and policymakers who seek to improve urban park development in high-density cities.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12942-021-00289-7.

Interactive Urban Play to Encourage Active Mobility: Usability Study of a Web-Based Augmented Reality Application

Owing to increasing cases of sedentary lifestyles and their negative impact on health, practical solutions are needed to address the physical and mental wellbeing of citizens and to enhance their standard of living. Among the problems are premature mortality rates caused by physical inactivity, which leads to chronic diseases. Innovative solutions are needed to address many of the problems that we face as a society. Location-based games have been identified as effective solutions for increasing physical activity, enhancing social interaction, and exploration in urban environments. In this pilot study, we explore how to encourage active mobility (walking and cycling) through urban play by integrating technology into the built environment. We examined the usability of a web-based augmented reality application in providing interactive experience to users as they explored the urban environment looking for tasks. Overall, participants’ perceptions of the usability of the application were positive; they enjoyed how the application revealed the tasks at each location and all the checkpoints at the different locations had at least a couple of visitors. We present limitations and future research directions.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

DISCUSSION

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

Medical encounters at community-based physical activity events (parkrun) in the UK

OBJECTIVE

To determine the incidence, clinical correlates and exposure risk of medical encounters during community-based physical activity events in the UK.

METHODS

An analysis of medical data from weekly, community-based physical activity events (parkrun) at 702 UK locations over a 6-year period (29 476 294 participations between 2014 and 2019) was conducted in order to define the incidence and clinical correlates of serious life-threatening, non-life-threatening and fatal medical encounters.

RESULTS

84 serious life-threatening encounters (overall incidence rate=0.26/100 000 participations) occurred including 18 fatalities (0.056/100 000 participations). Statistical modelling revealed that the probabilities of serious life-threatening encounters were exceptionally low, however, male sex, increasing age, slower personal best parkrun time and less prior running engagement/experience (average number of runs per year and number of years as a parkrun participant) were associated with increased probability of serious life-threatening encounters. These were largely accounted for by cardiac arrest (48/84, 57%) and acute coronary syndromes (20/84, 24%). Non-life-threatening medical encounters were mainly attributed to tripping or falling, with a reported incidence of 39.2/100 000 participations.

CONCLUSIONS

Serious life-threatening and fatal medical encounters associated with parkrun participation are extremely rare. In the context of a global public health crisis due to inactivity, this finding underscores the safety and corollary public health value of community running/walking events as a strategy to promote physical activity.

Daily physical activity, human development index and insomnia in a representative sample of Brazilian adolescents: a cross-sectional analysis

BACKGROUND

Although there is a growing body of research pointing towards the need to investigate how different movement behaviors, such as physical activity and sleep, influence each other, the joint relationship between these factors and insomnia has been little explored among adolescents in developing countries.

OBJECTIVES

To investigate the association between daily physical activity and insomnia in a national sample of Brazilian adolescents, according to the Human Development Index (HDI) of each Brazilian region.

DESIGN AND SETTINGS

Cross-sectional study on 102,072 Brazilian students aged 11 to 19 years, selected from all regions of the country.

METHODS

Information on insomnia and physical activity was self-reported by adolescents.

RESULTS

Our analyses revealed that girls who accumulated at least 60 minutes/day of physical activity on up to three days/week were less prone to present insomnia. This pattern of association was maintained only for those who lived in high HDI regions (odds ratio, 0.87; 95% confidence interval, 0.75-0.99). For boys, there was a positive association between the number of active days and protection against insomnia, especially for those who lived in high HDI regions.

CONCLUSION

Even amounts of physical activity that were lower than the weekly guidelines, were associated with better sleep quality for Brazilian adolescents, especially girls, and even for those who lived in regions with greater social and economic vulnerability.

Physical activity behaviours in adolescence: current evidence and opportunities for intervention

Young people aged 10-24 years constitute 24% of the world's population; investing in their health could yield a triple benefit-eg, today, into adulthood, and for the next generation. However, in physical activity research, this life stage is poorly understood, with the evidence dominated by research in younger adolescents (aged 10-14 years), school settings, and high-income countries. Globally, 80% of adolescents are insufficiently active, and many adolescents engage in 2 h or more daily recreational screen time. In this Series paper, we present the most up-to-date global evidence on adolescent physical activity and discuss directions for identifying potential solutions to enhance physical activity in the adolescent population. Adolescent physical inactivity probably contributes to key global health problems, including cardiometabolic and mental health disorders, but the evidence is methodologically weak. Evidence-based solutions focus on three key components of the adolescent physical activity system: supportive schools, the social and digital environment, and multipurpose urban environments. Despite an increasing volume of research focused on adolescents, there are still important knowledge gaps, and efforts to improve adolescent physical activity surveillance, research, intervention implementation, and policy development are urgently needed.

Environmental Factors Associated with Physical Activity in Rural U.S. Counties

Background: Rural U.S. adults’ prevalence of meeting physical activity (PA) guidelines is lower than urban adults, yet rural-urban differences in environmental influences of adults’ PA are largely unknown. The study’s objective was to identify rural-urban variations in environmental factors associated with the prevalence of adults meeting PA guidelines. Methods: County-level data for non-frontier counties (n = 2697) were used. A five-category rurality variable was created using the percentage of a county’s population living in a rural area. Factor scores from Factor Analyses (FA) were used in subsequent Multiple Linear Regression (MLR) analyses stratified by rurality to identify associations between environmental factor scores and the prevalence of males and females meeting PA guidelines. Results: FA revealed a 13-variable, four-factor structure of natural, social, recreation, and transportation environments. MLR revealed that natural, social, and recreation environments were associated with PA for males and females, with variation by sex for social environment. The natural environment was associated with PA in all but urban counties; the recreation environment was associated with PA in the urban counties and the two most rural counties. Conclusions: Variations across the rural-urban continuum in environmental factors associated with adults’ PA, highlight the uniqueness of rural PA and the need to further study what succeeds in creating active rural places.

Backyard benefits? A cross-sectional study of yard size and greenness and children's physical activity and outdoor play

BACKGROUND

The home environment is the most important location in young children's lives, yet few studies have examined the relationship between the outdoor home environment and child physical activity levels, and even fewer have used objectively measured exposures and outcomes. This study examined relationships between objectively assessed home yard size and greenness, and child physical activity and outdoor play.

METHODS

Data were drawn from the HealthNuts study, a longitudinal study of 5276 children in Melbourne, Australia. We used cross-sectional data from a sample at Wave 3 (2013-2016) when participants were aged 6 years (n = 1648). A sub-sample of 391 children had valid accelerometer data collected from Tri-axial GENEActive accelerometers worn on their non-dominant wrist for 8 consecutive days. Yard area and greenness were calculated using geographic information systems. Objective outcome measures were minutes/day in sedentary, light, and moderate-vigorous physical activity (weekday and weekend separately). Parent-reported outcome measures were minutes/day playing outdoors (weekend and weekday combined). Multi-level regression models (adjusted for child's sex, mother's age at the birth of child, neighbourhood socioeconomic index, maternal education, and maternal ethnicity) estimated effects of yard size and greenness on physical activity.

RESULTS

Data were available on outdoor play for 1648 children and usable accelerometer data for 391. Associations between yard size/greenness and components of physical activity were minimal. For example, during weekdays, yard size was not associated with daily minutes in sedentary behaviour (β: 2.4, 95% CI: - 6.2, 11.0), light physical activity (β: 1.4, 95% CI: - 5.7, 8.5) or MVPA (β: -2.4, 95% CI: - 6.5, 1.7), with similar patterns at weekends. There was no relationship between median annual yard greenness and physical activity or play.

CONCLUSION

In our study of young children residing in higher socio-economic areas of Melbourne yard characteristics did not appear to have a major impact on children's physical activity. Larger studies with greater variation in yard characteristics and identification of activity location are needed to better understand the importance of home outdoor spaces and guide sustainable city planning.

Resilience Reporting for Sustainable Development in Cities

Recently, a new paradigm has emerged—the resilient city. It is an evolutionary concept rooted in recent—but more consolidated—city visions, such as a smart city or a sustainable city, from which it inherits the interweaving of different dimensions. This paper investigates the factors behind effective resilience reporting, as well as how a city should draw up an urban resilience strategy report to be accountable to its citizens. We first highlighted the main factors to design and implement reporting for the achievement of strategic resilience goals, by combining research on a resilient city and accountability practices. These factors could be organized following two different perspectives: political and sociotechnical. Then, we applied our framework to four pioneering municipalities selected as paradigmatic case studies. A qualitative content analysis applied to the city resilience reports has provided depth to our framework. We found that the “weak factor” is the ability to embed the resilience strategy in rooted connections and transform itself into an ecosystem that crosscuts different sectoral urban processes. Our exploratory research claims could be used for future research in this field, as cities are becoming increasingly complex systems, where the quality of life and well-being of a larger population depends.

Effect of Space Configurational Attributes on Social Interactions in Urban Parks

Urban parks are one of the most common spaces for social interactions in modern cities. The design of park spaces, especially space configuration, has significant influences on people’s social behaviors in parks. In this study, the associations between space configurational attributes and social interactions were investigated using space syntax theory. An observation analysis of social behaviors was carried out in two urban parks in Beijing, China. Nine space configurational attributes, including depth to the gate, depth to the main road, connectivity, normalized angular integration (NAIN), and normalized angular choice (NACH) with three radii, were calculated using a segment model. The variance analysis and regression analysis reveal the strong joint effect of space type, space scale factors, and space configurational attributes on social interaction behaviors in parks. The personal interaction group contained 23% of the total observed people involved in social interactions. Pathway length, zone area, and NACH-10K (NACH with a radius of 10,000 m) are positively associated with the number of people involved in personal interactions. For the social interaction group (77% of the total observed people), the space scale and depth to main city road were found to have a positive and negative influence on social interaction intensity.

A Natural Experiment: Results of Community-Designed Park Improvements on Park Use and Physical Activity

The objective of this study was to assess if built environment changes to two suburban parks that involved extensive community engagement and physical activity programming increased park use and physical activity. This study employed a natural experiment evaluation design where community engagement informed the redesign of two neighborhood parks. Community engagement in the redesign of the parks was tracked as was the diversity of the partners on the steering committee and participation by community members in the process. Before and after park improvements, data were collected using the System for Observing Play and Recreation in Communities (SOPARC) instrument to measure change in use and activity level in each park. Park use increased at both parks, but physical activity levels did not significantly improve. The number of park visitors observed increased by 53% and 50%, respectively. Both parks had increased usage during evening hours when the family programming was the greatest. This study has several implications for policy and practice. First, this study suggests that community engagement can play a role in redesigning a park and likely leads to increased awareness and use of neighborhood parks. Second, while park use increased, simply adding new features to a park may not immediately increase physical activity. Additional efforts need to be made to activate the park and increase physical activity. Third, practitioners should not discount the value of building park awareness that increases park use as it may be a first step to increasing physical activity.

Do neighbourhood characteristics matter in understanding school children’s active lifestyles? A cross-region multi-city comparison of Glasgow, Edinburgh and Hong Kong

Many studies have explored the influence of individual and neighbourhood factors on active school travel (AST), this novel study is the first to examine how AST and formal extracurricular activities are associated with children’s active lifestyles. The aims of this study were to (a) create an active lifestyle variable (ALIFE) measured in terms of total weekly minutes of AST and extracurricular activities, and (b) explore how ALIFE is associated with different attributes at the individual, household and neighbourhood levels, and how these relationships differ for children aged 10 and 11 years old across the three cities: Glasgow, Edinburgh and Hong Kong. We found environmental factors to be important indicators of lower AST, for example greater parking facility density. The most substantial contribution to children’s overall ALIFE was household income, those from the lowest household group having almost 2 h less ALIFE per-week than those from the highest income.

Associations of park access, park use and physical activity in parks with wellbeing in an Asian urban environment: a cross-sectional study

BACKGROUND

Relationships between park access, park use, and wellbeing remain poorly understood. The objectives of this study were to investigate: (1) perceived and objective park access in relation to park use and physical activity in parks; and; (2) perceived and objective park access, park use and physical activity in parks and their associations with wellbeing.

METHODS

An interviewer-assisted survey collected data on perceived time to walk to parks, park use time, park physical activity time and wellbeing (using a scale containing nine domains) amongst adult participants of the Singapore Multi-Ethnic Cohort. Geospatial maps of parks and the "walkable" street networks were created for the city-state of Singapore to objectively determine distances to accessible points on park boundaries. Multiple linear regression models estimated the importance of park access to park use and associations of park access and park use with wellbeing, adjusting for potential confounders.

RESULTS

Participants' (n = 3435) average age was 48.8 years (SD, 12.8), 44.8% were male and 72.6% were of Chinese ethnicity. Better perceived but not true park access was significantly associated with greater park use. Park access (perceived or true) was not associated with physical activity time in parks. Greater participant park time and physical activity time in parks were associated with higher wellbeing scores (p < 0.001). The differences in wellbeing scores between the reference groups, who spent negligible time in parks, and the highest quartiles of time in parks (10.8 h/month) and physical activity in parks (8.3 h/month) were 3.2 (95% CI 2.1-4.4) and 4.2 (95% CI 4.1-6.3) points out of 100 respectively. These associations were similar for most domains of wellbeing, with clear dose-response relationships.

CONCLUSIONS

While perceived park access was strongly associated with park use and well-being, true park access was not, and neither park access measure was associated with park physical activity. Future studies could investigate the influence of park attributes on park use, physical activity in parks and wellbeing. The consistent associations of park use and particularly physical activity in parks with wellbeing suggest that promoting park use, and especially physical activity in parks, is a promising strategy for improving wellbeing in urban settings.

GPS-based built environment measures associated with adult physical activity

Studies often rely on home locations to access built environment (BE) influences on physical activity (PA). We use GPS and accelerometer data collected for 288 individuals over a two-week period to examine eight GPS-derived BE characteristics and moderate-to-vigorous PA (MVPA) and light-to-moderate-vigorous PA (LMVPA). NDVI, parks, blue space, pedestrian-orientated intersections, and population density were associated with increased odds of LMVPA and MVPA, while traffic air pollution and noise were associated with decreased odds of LMVPA and MVPA. Associations varied by population density and when accounting for multiple BE measures. These findings provide further information on where individuals choose to be physically active.

Functional Limitations and Perceived Neighborhood Walkability Among Urban Dwelling Older Adults

Older adults with functional limitations (FLs) often experience obstacles to walking. Although health promotion programs targeting physical activity are available in lower-income areas, few studies have compared the walking experiences of older adults who have FLs with those who do not in the community. The purpose of this cross-sectional survey was to compare perceptions of neighborhood walkability among older adults living in lower-income communities with and without FLs. Participants (N = 132) were recruited in 2018 at regional health clinics in Flint, Michigan. To be eligible, participants had to be 65 years of age or older, report no cognitive decline, and be Flint residents. Of the 132 participants, the mean age was 69.74 (SD = 4.97). The majority were female (66%); African American (77%); single, divorced, or widowed (72%); educated below the General Education Development level (57%), and had a FL (67%). Older adults with FLs were significantly (p < 0.05) less likely than those without to visit many places within walking distance, to have well-lit neighborhoods at night, and to reside in neighborhoods where sidewalks were separated from the road and traffic. Multiple regression analyses revealed that having a FL was associated with poorer neighborhood perceptions of mixed-land-use (b = −0.19, p < 0.05) and more walking hazards (b = −0.26, p < 0.05). Findings suggest that a FL is associated with perceptions of walkability. It is essential to develop disability-friendly support systems and accommodations to encourage walking in lower-income communities.

International evaluation of the Microscale Audit of Pedestrian Streetscapes (MAPS) Global instrument: comparative assessment between local and remote online observers

OBJECTIVES

The use of online imagery by non-local observers to conduct remote, centralized collection of streetscape audit data in international studies has the potential to enhance efficiency of collection and comparability of such data for research on built environments and health. The objectives of the study were to measure (1) the consistency in responses between local in-field observers and non-local remote online observers and (2) the reliability between in-country online observers and non-local remote online observers using the Microscale Audit of Pedestrian Streetscapes Global tool to characterize pedestrian-related features along streets in five countries.

METHODS

Consistency and inter-rater reliability were analyzed between local and non-local observers on a pooled database of 200 routes in five study regions (Melbourne, Australia; Ghent, Belgium; Curitiba, Brazil; Hong Kong, China; and Valencia, Spain) for microscale environmental feature subscales and item-level variables using the intraclass correlation coefficient (ICC).

RESULTS

A local in-field versus remote online comparison had an ICC of 0.75 (95 % CI: 0.68-0.80) for the grand total score. An ICC of 0.91 (95 % CI: 0.88-0.93) was found for the local online versus remote online comparison. Positive subscales yielded stronger results in comparison to negative subscales, except for the similarly poor-performing positive aesthetics/social characteristics.

CONCLUSIONS

This study demonstrated remote audits of microscale built environments using online imagery had good reliability with local in-field audits and excellent reliability with local online audits. Results generally supported remote online environmental audits as comparable to local online audits. This identification of low-cost and efficient data acquisition methods is important for expanding research on microscale built environments and physical activity globally.

Making sense of the evidence in population health intervention research: building a dry stone wall

To effectively tackle population health challenges, we must address the fundamental determinants of behaviour and health. Among other things, this will entail devoting more attention to the evaluation of upstream intervention strategies. However, merely increasing the supply of such studies is not enough. The pivotal link between research and policy or practice should be the cumulation of insight from multiple studies. If conventional evidence synthesis can be thought of as analogous to building a wall, then we can increase the supply of bricks (the number of studies), their similarity (statistical commensurability) or the strength of the mortar (the statistical methods for holding them together). However, many contemporary public health challenges seem akin to herding sheep in mountainous terrain, where ordinary walls are of limited use and a more flexible way of combining dissimilar stones (pieces of evidence) may be required. This would entail shifting towards generalising the functions of interventions, rather than their effects; towards inference to the best explanation, rather than relying on binary hypothesis-testing; and towards embracing divergent findings, to be resolved by testing theories across a cumulated body of work. In this way we might channel a spirit of pragmatic pluralism into making sense of complex sets of evidence, robust enough to support more plausible causal inference to guide action, while accepting and adapting to the reality of the public health landscape rather than wishing it were otherwise. The traditional art of dry stone walling can serve as a metaphor for the more ‘holistic sense-making’ we propose.

Associations between Community Built Environments with Early Care and Education Classroom Physical Activity Practices and Barriers

The influence of community-built environments on physical activity (PA) support in Early Childhood Education settings (ECEs) is unknown. The purpose of this cross-sectional study was to determine associations between community PA environments and ECE classroom PA practices. We included licensed Oklahoma ECE directors serving 3-to-5-year-old children. Parks and playground locations were exported from Google Earth. National Walkability Index was derived from 2010 US Census data. ArcMap 10.6 was used to geocode ECE locations, which were within an Activity Desert if no parks/playgrounds were located within a 1-mile radius or if Walkability Index was 10.5 or below. Classroom PA practices were determined by using the Nutrition and PA Self-Assessment tool (NAP SACC). Barriers to implementing practices were reported. Most Head Starts (n = 41; 80.3%), center-based childcare settings (CBC; n = 135; 87.0%), and family childcare homes (FCCHs; n = 153; 96.4%) were in an Activity Desert. Parks/playgrounds within a 10-mile buffer were correlated with classroom PA practices in FCCHs only (p < 0.001). Activity Desert status was not related to classroom PA practices for any ECE context (p > 0.029). While FCCHs may be the most vulnerable to lack of park and playground access, overall findings suggest ECEs provide a healthful micro-environment protective of the typical influence of community-built environments.