Identifying correlates of walking for exercise: an epidemiologic prerequisite for physical activity promotion

Perceived social and built environment associations of leisure-time physical activity among adults in Sri Lanka

OBJECTIVE

Although perceived neighbourhood environment is considered a predictor of leisure-time physical activity (LTPA), evidence for this is limited in South Asia. Thus, the aim was to determine the association between neighbourhood social and built environment features in carrying out LTPA among adults in Colombo District, Sri Lanka. A cross-sectional study among 1320 adults was carried out using validated questionnaires for physical activity (PA) and built environment data collection. Multiple logistic regression analysis was conducted to assess the associations between environment characteristics and LTPA after adjusting for gender, age, employment status, income level and sector of residence.

RESULTS

A total of 21.7% of adults participated in some LTPA. The commonest type of LTPA was walking; carried out by 14.5%. Moderate and vigorous activity at leisure was carried out by 10.3% and 3.9% respectively. Perceived social acceptance for PA was positively associated with LTPA. Out of the built environment characteristics perceived infrastructure for walking, and recreational facilities for PA were negatively associated with LTPA. Self-efficacy emerged as an important positive correlate of LTPA. The participants were positively influenced by the self-efficacy and perceived social environment which should be addressed when promoting LTPA.

Development of Measures of Perceived Neighborhood Environmental Attributes Influencing, and Perceived Barriers to Engagement in, Healthy Behaviors for Older Chinese Immigrants to Australia

Environmental correlates, barriers, and facilitators of physical activity, healthy eating, and socializing are understudied in older immigrants to developed countries. This study developed/adapted and validated measures of perceived barriers and neighborhood environmental characteristics related to these health-enhancing behaviors appropriate for older Chinese immigrants to Australia and similar Western countries. Older Chinese immigrants living in Melbourne (Australia) were recruited from neighborhoods varying in walkability and percentage of Chinese residents. Versions of the Neighborhood Environment for Healthy Aging–Chinese Immigrants to Australia (NEHA-CIA) questionnaire (20 subscales) and the Perceived Barriers to Health-Enhancing Behaviors questionnaire (four subscales) were developed from extant validated scales and information collected in formative qualitative research. Thirty-one participants took part in cognitive interviews aimed to pilot-test and refine the questionnaires. The modified questionnaires were administered to 52 participants twice, two weeks apart. Test-retest reliability (intraclass correlation coefficients), internal consistency (Cronbach’s α), and construct validity (associations with theoretically-relevant constructs) were examined. Most items and subscales of both questionnaires had good test-retest reliability and internal consistency, while the NEHA-CIA also showed good construct validity. Future studies need to further examine the construct validity of the questionnaire of perceived barriers and determine the factorial validity of both measures on large representative samples.

Rationale, design, and baseline characteristics of WalkIT Arizona: A factorial randomized trial testing adaptive goals and financial reinforcement to increase walking across higher and lower walkable neighborhoods

Little change over the decades has been seen in adults meeting moderate-to-vigorous physical activity (MVPA) guidelines. Numerous individual-level interventions to increase MVPA have been designed, mostly static interventions without consideration for neighborhood context. Recent technologies make adaptive interventions for MVPA feasible. Unlike static interventions, adaptive intervention components (e.g., goal setting) adjust frequently to an individual's performance. Such technologies also allow for more precise delivery of "smaller, sooner incentives" that may result in greater MVPA than "larger, later incentives". Combined, these factors could enhance MVPA adoption. Additionally, a central tenet of ecological models is that MVPA is sensitive to neighborhood environment design; lower-walkable neighborhoods constrain MVPA adoption and maintenance, limiting the effects of individual-level interventions. Higher-walkable neighborhoods are hypothesized to enhance MVPA interventions. Few prospective studies have addressed this premise. This report describes the rationale, design, intervention components, and baseline sample of a study testing individual-level adaptive goal-setting and incentive interventions for MVPA adoption and maintenance over 2 years among adults from neighborhoods known to vary in neighborhood walkability. We scaled these evidenced-based interventions and tested them against static-goal-setting and delayed-incentive comparisons in a 2 × 2 factorial randomized trial to increase MVPA among 512 healthy insufficiently-active adults. Participants (64.3% female, M age = 45.5 ± 9.1 years, M BMI = 33.9 ± 7.3 kg/m2, 18.8% Hispanic, 84.0% White) were recruited from May 2016 to May 2018 from block groups ranked on GIS-measured neighborhood walkability and socioeconomic status (SES) and classified into four neighborhood types: "high walkable/high SES," "high walkable/low SES," "low walkable/high SES," and "low walkable/low SES." Results from this ongoing study will provide evidence for some of the central research questions of ecological models.

Walkable Environments and Healthy Urban Moves: Urban Context Features Assessment Framework Experienced in Milan

Recent studies in public health have focused on determining the influences of the built environment on the population’s physical and mental health status. In order to promote active transport and physical activity, considered favorable behavior for the prevention non-communicable diseases (NCDs) such as obesity, it is necessary to reduce the negative effects of the built environment and develop positive ones, such as, for example, a walkable urban space. The aim of the research is to define a city’s walkability assessment framework capable of highlighting points of strength and weakness in its urban environment. All of the aspects that have a direct influence (evidence-based) on fostering the adoption of healthy lifestyles or promoting active transport as a strategy to increase the level of physical activity due to the existence of daily urban travel should be considered. After conducting a literature review aimed at identifying all of the existing assessment tools, 20 research studies were examined in detail. The new evaluation method arises from the comparison and critical selection of the various qualitative–quantitative indicators found, integrated into a multi-criteria analysis structure of dual-scale survey, with reference to walkability and paying attention to those indicators that have implications on health promotion. The new assessment framework, named Milano Walkability Measurement (MWM), is applicable in different urban contexts and was tested in two different areas of Milan. The Macro dimension (i.e., Density, Diversity, and Design criteria) refers to the urban scale and examines the city from a top view. It describes quantitatively the overall urban factors (urban area size equal to 1.5 Km2; typology of data: archival). The Micro dimension (i.e., Usefulness, Safeness, Comfort, and Aesthetics criteria) investigates the city at the street scale level. It describes qualitatively features of the outdoor spaces (road length of about 500/700 mt; typology of data: observational). Finally, the framework was weighted by comparison with a panel of experts. The expected results were reflected in the design recommendations based on the collected qualitative-quantitative data. The developed assessment method brings innovative criteria such as the multi-scaling assessment phase (Macro and Micro) and the ability to take into consideration aspects that according to the literature have relationships with health promotion linked to the improvement of a healthy lifestyle, related to daily active transportation choices. The design recommendations are useful both to policy-makers, to make evidence-based specific choices, and to designers, to understand what aspects of the urban environment must be improved or implemented in order to promote a walkable city.

Results from a natural experiment: initial neighbourhood investments do not change objectively-assessed physical activity, psychological distress or perceptions of the neighbourhood

BACKGROUND

Few studies have assessed objectively measured physical activity (PA), active transportation, psychological distress and neighborhood perceptions among residents of a neighborhood before and after substantial improvements in its physical environment. Also, most research-to-date has employed study designs subject to neighborhood selection, which may introduce bias in reported findings. We built upon a previously enrolled cohort of households from two low-income predominantly African American Pittsburgh neighborhoods, matched on socio-demographic composition including race/ethnicity, income and education. One of the two neighborhoods received substantial neighborhood investments over the course of this study including, but not limited to public housing development and greenspace/landscaping. We implemented a natural experiment using matched intervention and control neighborhoods and conducted pre-post assessments among the cohort. Our comprehensive assessments included accelerometry-based PA, active transportation, psychological distress and perceptions of the neighborhood, with assessments conducted both prior to and following the neighborhood changes. In 2013, we collected data from 1003 neighborhood participants and in 2016, we re-interviewed 676 of those participants. We conducted an intent to treat analysis, with a difference-in-difference estimator using attrition weighting to account for nonresponse between 2013 and 2016. In addition, we derived an individual-level indicator of exposure to neighbourhood investment and estimated effect of exposure to investment on the same set of outcomes using covariate-adjusted models.

RESULTS

We observed no statistically significant differences in activity, psychological distress, satisfaction with one's neighborhood as a place to live or any of the other measures we observed prior to and after the neighborhood investments between the intervention and control neighborhoods or those exposed vs not exposed to investments.

CONCLUSIONS

Using this rigorous study design, we observed no significant changes in the intervention neighborhood above and beyond secular trends present in the control neighborhood. Although neighborhood investment may have other benefits, we failed to see improvement in PA, psychological distress or related outcomes in the low-income African American neighborhoods in our study. This may be an indication that improvements in the physical environment may not directly translate into improvements in residents' physical activity or health outcomes without additional individual-level interventions. It is also possible that these investments were not dramatic enough to spur change within the three year period. Additional studies employing similar design with other cohorts in other settings are needed to confirm these results.

TRIAL REGISTRATION

Trial Registration is not applicable since we did not prospectively assign individuals to a health-related intervention.

Built Environment Features and Pedestrian Accidents: An Italian Retrospective Study

Daily walking is a recommended physical activity. It can be an all-age suitable, environment-friendly transport option. However, traffic crashes are a widely recognized risk factor, associated with drivers’ errors or a combination of several environmental factors, including physical characteristics of the road space. The aim of this study was to assess the characteristics of built environments on pedestrian safety. Data on road accidents that had occurred between 2005 and 2015, in Alghero, Italy, were retrieved and matched with spatial and functional street qualities. On-street parking was found to increase the risk of pedestrian accidents by about two times, whereas, narrow travel lanes and intersections reduced the incidence of crashes and their public relevance. These field results could inform urban health and spatial planning policies with the final goal of improving health and providing more sustainable models of urban organization.

The Effects of Length of Residence and Exposure to Violence on Perceptions of Neighborhood Safety in an Urban Sample

Perceptions of neighborhood safety shape the well-being of individuals and communities, affecting neighborhood walkability, associated physical activity behaviors, and health conditions. However, less is known about the factors that determine perceptions of safety. One factor that may affect perceptions of neighborhood safety is the length of time someone has lived in their neighborhood. We use a representative, adult sample of urban low-income residents from the 2015 New Haven Health Survey (n = 1189) to investigate the associations between length of residence (new residents of < 1 year in neighborhood versus longer-term residents of 1 or more years in neighborhood) and perceptions of neighborhood safety (whether feeling unsafe to walk at night). We then examine the potential moderating effect of exposure to neighborhood violence on these associations. We find that the association between length of residence and perceived safety differs by exposure to neighborhood violence. Among those unexposed to neighborhood violence, longer-term neighborhood residents were more likely to feel unsafe compared to new residents (OR = 2.03, 95% CI 1.19, 3.45). Additionally, the effect of exposure to violence on feelings of safety was larger for new residents (OR = 9.10, 95% CI 2.72, 30.44) compared to longer-term residents (OR = 1.88, 95% CI 1.28, 2.77). Our findings suggest that length of residence may have implications for feelings of safety, and that experiences of violence may uniquely contribute to feelings of unsafety among new residents. These findings hold implications for interventions and policy efforts aimed at neighborhood safety improvements through community development, housing, or city urban planning initiatives, particularly for new neighborhood residents or those who experience neighborhood violence.

Community-based physical activity as adjunctive smoking cessation treatment: Rationale, design, and baseline data for the Lifestyle Enhancement Program (LEAP) randomized controlled trial

Despite advances in behavioral and pharmacological treatment for tobacco use and dependence, quit rates remain suboptimal. Increasing physical activity has shown some promise as a strategy for improving cessation outcomes. However, initial efficacy studies focused on intensive, highly structured exercise programs that may not be applicable to the general population of smokers. We describe the rationale and study design and report baseline participant characteristics from the Lifestyle Enhancement Program (LEAP), a two-group, randomized controlled trial. Adult smokers who engaged in low levels of leisure time physical activity were randomly assigned to treatment conditions consisting of an individualized physical activity intervention delivered by health fitness instructors in community-based exercise facilities or an equal contact wellness control. All participants received standard cognitive behavioral smoking cessation counseling combined with nicotine replacement therapy. The primary outcomes are seven-day point prevalence abstinence at seven weeks, six- and 12 months. Secondary outcomes include self-reported physical activity, dietary intake, body mass index, waist circumference, percent body fat, and nicotine withdrawal symptoms. Participants consist of 392 sedentary smokers (mean [standard deviation] age = 44.6 [10.2] = years; 62% female; 31% African American). Results reported here provide information regarding experiences recruiting smokers willing to change multiple health behaviors including smoking and physical activity.

The contribution of area-level walkability to geographic variation in physical activity: a spatial analysis of 95,837 participants from the 45 and Up Study living in Sydney, Australia

BACKGROUND

Individual-level studies support a positive relation between walkable built environments and participation in moderate-intensity walking. However, the utility of this evidence for population-level planning is less clear as it is derived at much finer spatial scales than those used for regional programming. The aims of this study were to: evaluate if individual-level relations between walkability and walking to improve health manifest at population-level spatial scales; assess the specificity of area-level walkability for walking relative to other moderate and vigorous physical activity (MVPA); describe geographic variation in walking and other MVPA; and quantify the contribution of walkability to this variation.

METHODS

Data on sufficient walking, sufficient MVPA, and high MVPA to improve health were analyzed for 95,837 Sydney respondents to the baseline survey of the 45 and Up Study between January 2006 and April 2010. We used conditional autoregressive models to create smoothed MVPA "disease maps" and assess relations between sufficient MVPA to improve health and area-level walkability adjusted for individual-level demographic, socioeconomic, and health factors, and area-level relative socioeconomic disadvantage.

RESULTS

Within-cohort prevalence of meeting recommendations for sufficient walking, sufficient MVPA, and high MVPA were 31.7 (95% CI 31.4-32.0), 69.4 (95% CI 69.1-69.7), and 56.1 (95% CI 55.8-56.4) percent. Prevalence of sufficient walking was increased by 1.20 (95% CrI 1.12-1.29) and 1.07 (95% CrI 1.01-1.13) for high and medium-high versus low walkability postal areas, and for sufficient MVPA by 1.05 (95% CrI 1.01-1.08) for high versus low walkability postal areas. Walkability was not related to high MVPA. Postal area walkability explained 65.8 and 47.4 percent of residual geographic variation in sufficient walking and sufficient MVPA not attributable to individual-level factors.

CONCLUSIONS

Walkability is associated with area-level prevalence and geographic variation in sufficient walking and sufficient MVPA to improve health in Sydney, Australia. Our study supports the use of walkability indexes at multiple spatial scales for informing population-level action to increase physical activity and the utility of spatial analysis for walkability research and planning.

Attitudes and Barriers to Healthy Diet and Physical Activity: A Latent Profile Analysis

Healthy diet and physical activity (PA) prevent and reduce chronic disease. Social cognitive theory delineates multiple attitudes and barriers that influence these behaviors. Understanding covariation in these attitudes and barriers is complex. We examined whether individuals could be grouped into a small number of categories that are easier to study. Interviews were conducted with 982 adults from two low-income, predominantly African American neighborhoods in the same city. Social cognitive constructs, including self-efficacy, social norms, and internal and external barriers to diet and exercise, and walking were self-reported. We measured moderate to vigorous physical activity with accelerometers and diet with 24-hour recalls. We conducted a latent profile analysis of attitudes and barriers to diet and PA and identified four classes: (a) moderate diet and negative exercise attitudes, where participants were roughly average on dietary attitudes but reported exercise-related challenges, including lower social support, outcome expectancies, physical functioning, and self-efficacy; (b) few barriers and benefits of healthy diet and exercise, where participants reported fewer barriers and lower outcome expectancies for diet and PA; (c) moderate overall attitudes, where participants had average scores on most indicators but below-average exercise self-efficacy and slightly more exercise barriers; and (d) positive overall attitudes, characterized by more positive attitudes toward both diet and PA across most domains, particularly regarding self-efficacy to overcome exercise barriers. These profiles could inform efforts to tailor individual-level interventions for diet and PA of persons at high risk of chronic diseases.

Walking and Bicycling: An Evaluation of Environmental Audit Instruments

Purpose.

This paper reviews existing environmental audit instruments used to capture the walkability and bikability of environments. The review inventories and evaluates individual measures of environmental factors used in these instruments. It synthesizes the current state of knowledge in quantifying the built environment. The paper provides health promotion professionals an understanding of the essential aspects of environments influencing walking and bicycling for both recreational and transportation purposes. It serves as a basis to develop valid and efficient tools to create activity-friendly communities.

Data Sources.

Keyword searches identified journal articles from the computer-based Academic Citation Databases, including the National Transportation Library, the Web of Science Citation Database, and MEDLINE. Governmental publications and conference proceedings were also searched.

Study Inclusion and Exclusion Criteria.

All instruments to audit physical environments have been included in this review, considering both recreation- and transportation-related walking and bicycling. Excluded are general methods devised to estimate walking and cycling trips, those used in empirical studies on land use and transportation, and research on walking inside buildings.

Data Extraction Methods.

Data have been extracted from each instrument using a template of key items developed for this review. The data were examined for quality assurance among three experienced researchers.

Data Synthesis.

A behavioral model of the built environment guides the synthesis according to three components: the origin and destination of the walk or bike trip, the characteristics of the road traveled, and the characteristics of the areas surrounding the trip's origin and destination. These components, combined with the characteristics of the instruments themselves, lead to a classification of the instruments into the four categories of inventory, route quality assessment, area quality assessment, and approaches to estimating latent demand for walking and bicycling. Furthermore, individual variables used in each instrument to measure the environment are grouped into four classes: spatiophysical, spatiobehavioral, spatiopsychosocial, and policy-based.

Major Conclusions.

Individually, existing instruments rely on selective classes of variables and therefore assess only parts of built environments that affect walking and bicycling. Most of the instruments and individual measures have not been rigorously tested because of a lack of available data on walking and bicycling and because of limited research budgets. Future instrument development will depend on the acquisition of empirical data on walking and bicycling, on inclusion of all three components of the behavioral model, and on consideration of all classes of variables identified.

Integrating the Perceived Neighborhood Environment and the Theory of Planned Behavior When Predicting Walking in a Canadian Adult Sample

Purpose.

To integrate the characteristics of the perceived environment with the theory of planned behavior (TPB) to determine (1) whether the TPB mediates relations among environmental characteristics and walking, and (2) whether the environment moderates TPB-walking relations.

Design.

Cross-sectional.

Setting.

South Vancouver Island, British Columbia, Canada.

Subjects.

Random sample of 351 adults (36% response rate).

Measures.

Participants completed measures of the perceived neighborhood environment, the TPB, and walking behavior that was assessed using an adapted Godin leisure time questionnaire.

Results.

Results using structural equation modeling indicated that the TPB mediated the environment-walking relationship. Specifically, retail land-mix use and neighborhood aesthetics were associated with walking through affective and instrumental attitudes. Results using moderated regression analyses showed that recreation land-mix use moderated the intention-behavior relationship, with those individuals who perceived closer access to recreation facilities having a larger intention-behavior relationship. A significant moderating effect for crime on the instrumental attitude-intention relationship was also identified, but the effect size was small to trivial.

Conclusions.

These results suggest that the perceived neighborhood may influence walking through attitudes and may also influence the intention-behavior gap. Prospective studies using objective walking and environment data are required to improve the veracity of the findings and to identify possible causal relationships.

The Relationship between Convenience of Destinations and Walking Levels in Older Women

Purpose.

To examine the relationship between physical activity and (1) convenience of destinations, measured by whether destinations (such as a park, trail, businesses, and services) are within walking distance of the home, and (2) participants' perception of the quality of their neighborhood surroundings for walking, captured with a global neighborhood “walkability” rating.

Design.

Cross-sectional analysis of data obtained in 1999.

Setting.

Community in southwest Pennsylvania.

Subjects.

Older Caucasian women (n = 149, mean age = 74.2 years). Response rate = 79%.

Measures.

Walking levels, leisure-time physical activity, and features of the neighborhood environment were measured with interviewer-administered questionnaires. Physical activity was also measured objectively with a pedometer.

Results.

Living within walking distance (defined as within a 20-minute walk of home) of a park; biking or walking trail; or department, discount, or hardware store was related to higher pedometer readings ( p < .01). In addition, there was a positive trend between the sum of destinations within walking distance of home and activity levels measured by pedometer and questionnaire ( p < .01). There was also a positive trend between participants' neighborhood “walkability” rating and activity levels measured by pedometer and questionnaire ( p < .01).

Conclusion.

These findings suggest that the ability to make utilitarian walking trips from home and the perception of having favorable neighborhood surroundings for walking are associated with increased physical activity levels in older women.

Linking Perceptions of the Community to Behavior: Are Protective Social Factors Associated with Physical Activity?

Although the relationship of psychosocial factors to physical activity has been explored, there is increased interest in how perceptions of the community environment influence behavior.However, few methodological studies have incorporated perceptions of the social and community environment (protective social factors) or addressed key measurement issues.Computer-assisted telephone interviews were administered to a national sample of 1, 818 U.S.adults.Unadjusted and multivariate-adjusted odds ratios were calculated to compare active and inactive participants by Protective Social Factors (PSF) scores and selected sociodemographics. Confirmatory factor analysis and reliability analysis suggested strong PSF scale psychometric properties (• =. 92). After adjustment for potential confounders, a 10-point rise in the PSF score resulted in a 12% increased likelihood of meeting Centers for Disease Control and Prevention/American College of Sports Medicine recommendations. Additional analyses indicated that greater perceived PSFs were associated with meeting these recommendations among Whites but not among African Americans.

Ready to be Physically Active? The Effects of a Course Preparing Low-Income Multiethnic Women to be more Physically Active

The purpose of this study is to evaluate the effect of a preintervention physical activity preparatory course on physical activity, and social, cognitive, and transtheoretical constructs. The sample included 82 low-income, multiethnic women (75% Latina) who completed an 8-week course designed to prepare them to become more active prior to randomization into a 10-month physical activity intervention. Participants completed precourse and postcourse measures. Paired-comparison t tests showed increases in knowledge, perceived social support for exercise, minutes of walking per week, and total cognitive and behavioral processes following the preparatory course. Perceived barriers and self-efficacy for exercise did not change from precourse to postcourse. Preintervention preparatory courses may be an effective way to increase social and cognitive constructs associated with physical activity behavior, potentially yielding a greater effect from subsequent interventions.

An Emergent Theoretical Model for Interventions Encouraging Physical Activity (Mall Walking) Among Older Adults

The meaning of and motivations for mall walking among older adults over the age of 60 are explored based on the findings of a qualitative study of mall walkers at a single site. Findings suggest that elements of three extant theoretical frameworks are relevant for promoting physical activity in this age group: (a) symbolic interactionism, (b) social cognitive theory, and (c) social breakdown and competence. This article proposes a synthesis of certain aspects of these three theoretical orientations into a theoretical model for interventions encouraging a popular type of unsupervised physical activity, mall walking, among independent, community-dwelling older adults.

How are physical activity behaviors and cardiovascular risk factors associated with characteristics of the built and social residential environment?

Background

The aim of our study was to identify perceptions of built and social residential characteristics and their association with behaviors such as physical activity (PA), nutrition and smoking and with cardiovascular risk factors (elevated BMI and fasting blood glucose).

Methods

Among participants of a preventive medical checkup at an Austrian District Health Insurance Fund (n=904, response rate = 82.2%, 42% women, 18-91 years) self-reported and measured data were collected.

Results

Total PA was positively associated with the presence of trees along the streets and high levels of pro-physical activity social modeling (SM) and it was negatively related to perceived safety from crime. More leisure-time PA was associated with higher levels of cycling/walking infrastructure and high levels of SM. PA for transportation was positively related to high levels of connectivity and high levels of SM. Better behavioral cardiovascular risk factor profiles (smoking and nutrition) were associated with high levels of SM and high levels of total PA. Lower BMI values were associated with high levels of infrastructure and high levels of SM.

Conclusions

Both built and social residential characteristics are important correlates of PA as well as of major cardiovascular risk factors besides PA.

Neighborhood Disadvantage, Physical Activity Barriers, and Physical Activity among African American Breast Cancer Survivors

BACKGROUND

In view of evidence that African American cancer survivors experience the greatest challenges in maintaining adequate levels of physical activity, this cross-section study was designed to determine whether individual and residential environment characteristics are associated with physical activity in this population.

METHODS

A total of 275 breast cancer survivors completed self-report items measuring sociodemographic variables, physical activity, and select barriers to physical activity in Spring of 2012. Neighborhood disadvantage variables were extracted from national databases. Regression models were computed to assess relationships.

RESULTS

Traditional correlates of smoking status and the presence of health complications were associated with physical activity. In addition, the relative number of renters versus homeowners in one's neighborhood was associated with lower levels of physical activity in the context of individual level barriers (i.e., interest and space), which were also associated with lower levels of physical activity.

DISCUSSION

Higher renter rates and individual barriers both contribute to lower levels of physical activity in African American breast cancer survivors. These data suggest that the potential for constant residential turnover (via rentership) and perceived barriers may increase physical inactivity even where facilities may be available.

Interactive effects of built environment and psychosocial attributes on physical activity: a test of ecological models

BACKGROUND

The principle of cross-level interactions of influence on behavior in ecological models is seldom studied.

PURPOSE

To examine built environment × psychosocial interactive effects on physical activity.

METHODS

Multi-level mixed regression analyses used data from the Neighborhood Quality of Life Study conducted in neighborhoods in two US regions (n = 2,199 adults). Outcomes were (1) objectively measured moderate-to-vigorous physical activity, (2) reported transport walking, and (3) leisure-walking. Conceptually matched built environment variables were analyzed for domain-specific outcomes.

RESULTS

With leisure walking as the outcome, built environment × psychosocial interactions were significant in 7 of 20 models tested. Directions of interactions were consistent, indicating a stronger built environment-leisure walking association in adults with less favorable psychosocial status. Little evidence supported such interactions with objectively measured moderate-to-vigorous physical activity or transport walking as outcomes.

CONCLUSION

The results imply that the built environment may exert stronger influence on adults who are not psychologically predisposed to be active.

Associations among environmental supports, physical activity, and blood pressure in African-American adults in the PATH trial

High blood pressure disproportionately affects African-American adults and is a leading cause of stroke and heart attack. Engaging in recommended levels of physical activity reduces blood pressure, and social and physical environmental supports for physical activity may increase engagement in physical activity. Based on social cognitive theory within a bioecological framework, the present study tested hypotheses that perceived peer social support for physical activity and neighborhood walkability would be positively associated with physical activity, and that physical activity would mediate their relation with blood pressure. Baseline data were collected with 434 African-American adults in underserved communities (low income, high crime) participating in the Positive Action for Today's Health (PATH) trial. Perceived peer social support for physical activity and neighborhood walkability were measured with validated surveys. Physical activity was assessed with 7-day accelerometry (moderate-to-vigorous physical activity, min/day) and with a 4-week recall of walking. Three blood pressure assessments were taken by trained staff using standard protocols, with values from the second and third assessments averaged. The sample was predominantly female (63%), overweight (mean body mass index = 30.9, SD = 8.4), and had slightly elevated blood pressures with a mean systolic blood pressure of 132.4 (SD = 17.9) and a mean diastolic blood pressure of 81.4 (SD = 11.0). Results demonstrated that peer social support for physical activity (B = 2.43, p = .02) and neighborhood walkability (B = 2.40, p = .046) were significantly related to average daily moderate-to-vigorous physical activity. Neighborhood walkability was also significantly associated with self-reported average daily walking (B = 8.86, p = .02). Physical activity did not mediate their relation with blood pressure and no significant direct effects of these variables on blood pressure were found. The positive influence of social and physical environmental supports on physical activity in underserved African-American communities may guide intervention efforts and contribute to our understanding of physical activity and related health outcomes.

Attrition and adherence of young women to aerobic exercise: lessons from the WISER study

The purpose of this report is to identify factors associated with attrition and adherence of young women to a 16-week randomized aerobic exercise intervention on biomarkers associated with breast cancer risk. The exercise group was prescribed a progressive weight-bearing aerobic exercise program consisting of 30 minute workouts, 5 times/wk for 16 weeks. Adherence was calculated as the average minutes of exercise per week during participation in the study. Of the total of 212 women randomized into the exercise intervention 46 dropped out, of which 82.5% dropped out during the earlier stages of exercise suggesting that reasons for withdrawal may have been related to difficulties with initiating physical activity. Time commitment or lack of time was the primary reason for withdrawal. Drop outs reported lower physical activity at baseline than study completers (p=.0007). Although 78% of the 212 randomized participants completed the exercise intervention, only 4.7% of the participants exercised for at least 150 min/wk during the entire study period. Significant predictors of adherence were self-reported physical activity at baseline and depression scores. We conclude that predictors of adherence to exercise in our population of young women are similar to those reported for older adults. We also found that young women are more likely to exercise at moderate to vigorous intensity for 90 to 120 min rather than 150 min per week, even when participating in a highly structured exercise intervention.

Fear of injury with physical activity is greater in adults with diabetes than in adults without diabetes

OBJECTIVE

Physical activity is a cornerstone of treatment for diabetes, yet people with diabetes perform less moderate and vigorous physical activity (MVPA) than people without diabetes. In contrast, whether differences in walking activity exist has been understudied. Diabetes-specific barriers to physical activity are one possible explanation for lower MVPA in diabetes. We hypothesized that people with diabetes would perform less walking and combined MVPA and would be less likely to anticipate increasing physical activity if barriers were theoretically absent, compared with people without diabetes.

RESEARCH DESIGN AND METHODS

We surveyed 1,848 randomly selected rural Colorado adult residents by telephone from 2002 to 2004. Respondents reported weekly walking and MVPA duration and their likelihood of increasing physical activity if each of seven barriers was theoretically absent.

RESULTS

People with diabetes (n = 129) had lower odds of walking and MVPA than people without diabetes (walking: adjusted odds ratio 0.62 [95% CI 0.40-0.95]; MVPA: adjusted odds ratio 0.60 [0.36-0.99]; ≥10 vs. <10 min/week, adjusted for age, sex, BMI, and ethnicity). Respondents with diabetes reported fear of injury as a barrier to physical activity more often than respondents without diabetes (56 vs. 39%; P = 0.0002), although this relationship was attenuated after adjusting for age and BMI (adjusted odds ratio 1.36 [0.93-1.99]).

CONCLUSIONS

Although walking is a preferred form of activity in diabetes, people with diabetes walk less than people without diabetes. Reducing fear of injury may potentially increase physical activity for people with diabetes, particularly in older and more overweight individuals.

Adults' physical activity patterns across life domains: cluster analysis with replication

OBJECTIVE

Identifying adults' physical activity patterns across multiple life domains could inform the design of interventions and policies.

DESIGN

Cluster analysis was conducted with adults in two U.S. regions (Baltimore/Washington, DC, n = 702; Seattle, WA [King County], n = 987) to identify different physical activity patterns based on adults' reported physical activity across four life domains: leisure, occupation, transport, and home. Objectively measured physical activity, and psychosocial and built (physical) environment characteristics of activity patterns were examined.

MAIN OUTCOME MEASURES

Accelerometer-measured activity, reported domain-specific activity, psychosocial characteristics, built environment, body mass index.

RESULTS

Three clusters replicated (κ = .90-.93) across both regions: Low Activity, Active Leisure, and Active Job. The Low Activity and Active Leisure adults were demographically similar, but Active Leisure adults had the highest psychosocial and built environment support for activity, highest accelerometer-measured activity, and lowest body mass index. Compared to the other clusters, the Active Job cluster had lower socioeconomic status and intermediate accelerometer-measured activity.

CONCLUSION

Adults can be clustered into groups based on their patterns of accumulating physical activity across life domains. Differences in psychosocial and built environment support between the identified clusters suggest that tailored interventions for different subgroups may be beneficial.

Psychosocial correlates of leisure-time walking among Australian adults of lower and higher socio-economic status

Adults of lower socio-economic status (SES) participate less in physical activity than those of higher SES. Understanding the correlates of physical activity participation and how these may differ between socio-economic groups can inform policies and physical activity promotion strategies. The psychosocial correlates of leisure-time walking (the most common voluntary physical activity of adults) were assessed using a survey of 2488 randomly sampled Australian adults (response rate = 74.2%). Among respondents of higher SES, there were higher levels of positive cognitions towards physical activity, and walking for leisure was more prevalent than among those of lower SES. Relationships of psychosocial attributes with leisure-time walking differed by SES. The strongest correlate of leisure-time walking was perceived barriers for lower SES adults and enjoyment for those of higher SES. Social support from friends was associated with walking for both groups, while the effect of support from family was significant only for adults of lower SES. Strategies influencing leisure-time walking may have to target the specific needs of different socio-economic groups. For example, removing perceived barriers may be more appropriate to promote walking among lower SES adults. Interventions tailored for lower SES groups may help close the socio-economic gap in physical activity participation.

Local environments as determinants of walking in Melbourne, Australia

Structural changes to neighbourhoods that promote walking are likely to benefit everyone in a community and result in long-term improvements in the population's physical activity and health. We consider time spent walking in relation to objectively measured features of people's local environments (functionality, safety, destinations and aesthetics) in Melbourne, Australia. We used multilevel ordered logistic regression analysis to examine variations in time spent walking amongst 2334 residents of 49 small areas (Census Collection Districts - CCDs). Features on each street segment within a 400 m radius of a randomly selected household within each CCD were measured, supplemented by geographic information system data. Models were adjusted for socio-demographic and socio-economic characteristics of individual and socio-economic characteristics of areas. We found that increasing track length, having paths located closer to roads, fewer buildings with driveways, a greater presence and variety of destinations and views of shops, light industry, offices and/or schools (commercial views) were associated with more time spent walking in local environments in adjusted models. As such, each of the four features of local environments considered (design, safety, destinations and aesthetics) were associated on at least one measure with walking. Characteristics of areas reflecting urbanisation (destinations, commercial views, path location and driveways) were associated with increased time spent walking. This study provides important evidence on how urban design can be utilised to improve physical activity.

Striding toward social justice: the ecologic milieu of physical activity

Disparities in physical activity should be investigated in light of social justice principles. This article critically evaluates evidence and trends in disparities research within an ecologic framework, focusing on multilevel factors such as neighborhood and racial discrimination that influence physical activity. Discussion focuses on strategies for integrating social justice into physical activity promotion and intervention programming within an ecologic framework.

Explaining socio-economic status differences in walking for transport: an ecological analysis of individual, social and environmental factors

The identification of potential mechanisms of influence (mediators) of socio-economic status (SES) on walking for transport is important, because the likely opposing forces of influence may obscure pathways for intervention across different SES groups. This study examined individual, and perceived social and physical environmental mediators of the relations of individual- and area-level SES with walking for transport. Two mailed surveys, six months apart, collected data on transport-related walking and its hypothesized individual, social and environmental correlates. The sample consisted of 2194 English-speaking adults (aged 20-65) living in 154 Census Collection Districts (CCDs) of Adelaide, Australia. Individual-level SES was assessed using data on self-reported educational attainment, household income, and household size. Area-level SES was assessed using census data on median household income and household size for each selected CCD. Bootstrap generalized linear models examined associations between SES, potential mediators, and total weekly minutes and frequency of walking for transport. The product-of-coefficient test was used to assess mediating effects. Individual, social-environmental, and physical environmental factors significantly contributed to the explanation of the relations between SES and transport-related walking frequency. Educational attainment and area- and individual-level income played independent roles in explaining frequency of walking for transport, through opposing common and distinct pathways. While engagement in leisure-time physical activity was the most influential mediator of the association between educational attainment and frequency of walking for transport, the number of motorized vehicles and perceived levels of environmental aesthetics and greenery were the strongest mediators of the relations of frequency of transport-related walking with individual- and area-level income, respectively. Environmental interventions aimed at increasing residential density, reducing physical barriers to walking and traffic load, developing social-support networks, and creating greener and more aesthetically pleasing environments in more-disadvantaged areas may help to reduce SES inequalities in participation in physical activity, by facilitating walking for transport.

Impact of health perception, balance perception, fall history, balance performance, and gait speed on walking activity in older adults

BACKGROUND AND PURPOSE

Disagreement currently exists regarding the contributions of various factors to physical activity in older adults. The purpose of this cross-sectional study was to investigate the simultaneous impact of psychological (health perception and balance perception) and physiological (gait speed, fall history, and balance performance) factors on walking activity in older adults.

SUBJECTS AND METHODS

This cross-sectional secondary data analysis included 2,269 community-dwelling older adults from the Cardiovascular Health Study. A series of simultaneous linear regression models were constructed to examine the association of walking activity with health and balance perception, gait speed, fall history, and balance performance after controlling for potential confounding factors.

RESULTS

Health and balance perception and gait speed were significantly related to walking activity after controlling for potential confounding factors. Participants who perceived both their health and their balance to be good walked more blocks per week than those who reported a discordant perception, who walked more than those who perceived both their health and their balance to be poor. Participants who walked at a normal speed walked more blocks per week than those who walked at a slow speed.

DISCUSSION AND CONCLUSION

The measure of physical activity used in this study included only walking, not other low- to moderate-intensity activities that are common in older adults. Health and balance perception and gait speed were associated with walking activity more so than fall history or balance performance after controlling for potential confounding factors.

The 'Walking for Wellbeing in the West' randomised controlled trial of a pedometer-based walking programme in combination with physical activity consultation with 12 month follow-up: rationale and study design

Background

Scotland has a policy aimed at increasing physical activity levels in the population, but evidence on how to achieve this is still developing. Studies that focus on encouraging real world participants to start physical activity in their settings are needed. The Walking for Well-being in the West study was designed to assess the effectiveness of a pedometer-based walking programme in combination with physical activity consultation. The study was multi-disciplinary and based in the community. Walking for Well-being in the West investigated whether Scottish men and women, who were not achieving the current physical activity recommendation, increased and maintained walking behaviour over a 12 month period. This paper outlines the rationale and design of this innovative and pragmatic study.

Methods

Participants were randomised into two groups: Group 1: Intervention (pedometer-based walking programme combined with a series of physical activity consultations); Group 2: Waiting list control for 12 weeks (followed by minimal pedometer-based intervention). Physical activity (primary outcome) was measured using pedometer step counts (7 day) and the International Physical Activity Questionnaire (long version). Psychological processes were measured using questionnaires relating to the Transtheoretical Model of Behaviour Change, mood (Positive and Negative Affect Schedule) and quality of life (Euroqol EQ-5D instrument). Physiological measures included anthropometric and metabolic outcomes. Environmental influences were assessed subjectively (Neighbourhood Quality of Life Survey) and objectively (neighbourhood audit tool and GIS mapping). The qualitative evaluation employed observation, semi-structured interviews and focus groups. A supplementary study undertook an economic evaluation.

Discussion

Data analysis is on-going. Walking for Well-being in the West will demonstrate if a pedometer based walking programme, in combination with physical activity consultation results in a sustainable increase in walking behaviour in this sample of Scottish adults over a 12 month period. The study will examine the complex relationships between behavioural change, health consequences and the role of the environment, in conjunction with the cost effectiveness of this approach and a detailed insight into the participants' experiences of the intervention.

Trial registration

Current Controlled Trials ISRCTN88907382

Feasibility and outcomes of a multilevel place-based walking intervention for seniors: a pilot study

This pilot study tested the feasibility and acceptability of a novel multilevel walking intervention for older adults in a continuing care retirement community (CCRC). The intervention included site-specific walking route maps, pedometers, and individualized goal setting. Pedometers were worn for self-monitoring and for the primary outcome (steps per day). Surveys at pre- and post-intervention assessed daily activities, benefits, barriers, route use, quality of life, and satisfaction. Steps per day were very low at baseline and increased significantly at post-test. The findings indicate that a multilevel site-specific intervention is feasible and acceptable for increasing steps among seniors living in a CCRC.

Covariation of adolescent physical activity and dietary behaviors over 12 months

PURPOSE

This study examined covariation among changes in dietary, physical activity, and sedentary behaviors over 12 months among adolescents participating in a health behavior intervention. Evidence of covariation among behaviors would suggest multi-behavior interventions could have synergistic effects.

METHODS

Prospective analyses were conducted with baseline and 12-month assessments from a randomized controlled trial to promote improved diet, physical activity, and sedentary behaviors (experimental condition) or SUN protection behaviors (comparison condition). Participants were adolescent girls and boys (N = 878) aged 11-15 years on entry. The main outcomes were: diet, based on multiple 24-hour recalls (total fat, grams of fiber, servings of fruit and vegetables, total calories); average daily energy expenditure (kcals/kg) based on 7-day physical activity recall interviews; daily minutes of moderate-vigorous physical activity minutes from accelerometery; and self-reported daily hours of sedentary behavior.

RESULTS

Covariation was found between fat and calories (r = .16), fiber and calories (r = .53), fiber and fruit/vegetables (r = .53), calories and fruit/vegetables (r = .34), and fruit and vegetables and sedentary behavior (r = -.12) for the total sample (all p values < .01). The pattern of findings was similar for most subgroups defined by gender and study condition.

CONCLUSIONS

The strongest covariation was observed for diet variables that are inherently related (calories and fat, fiber, and fruit/vegetables). Little covariation was detected within or between other diet, physical activity and sedentary behavior domains suggesting that interventions to improve these behaviors in adolescents need to include specific program components for each target behavior of interest.

Potential environmental determinants of physical activity in adults: a systematic review

The objective of this systematic review of observational studies was to gain insight into potential determinants of various types and intensities of physical activity among adult men and women. Studies were retrieved from Medline, PsycInfo, Embase and Social scisearch. The ANGELO framework was used to classify environmental factors. In total, 47 publications were identified. Social support and having a companion for physical activity were found to be convincingly associated with different types of physical activity [(neighbourhood) walking, bicycling, vigorous physical activity/sports, active commuting, leisure-time physical activity in general, sedentary lifestyle, moderately intense physical activity and a combination of moderately intense and vigorous activity]. Availability of physical activity equipment was convincingly associated with vigorous physical activity/sports and connectivity of trails with active commuting. Other possible, but less consistent correlates of physical activity were availability, accessibility and convenience of recreational facilities. No evidence was found for differences between men and women. In conclusion, supportive evidence was found for only very few presumed environmental determinants. However, most studies used cross-sectional designs and non-validated measures of environments and/or behaviour. Therefore, no strong conclusions can be drawn and more research of better quality is clearly needed.

The physical environment and physical activity: a critical appraisal of review articles

BACKGROUND

Over the last few years an increasing number of studies investigating the association between the physical environment and physical activity have been published. Many reviews have also summarized this emerging body of research, and such review papers are frequently used by public health policymakers and researchers themselves to inform decision making.

METHODS

This paper systematically appraises methodologic aspects of literature reviews examining the relationship between physical activity and the physical environment published in peer-reviewed journals between 2000 and 2005. Eleven reviews and their antecedent source papers were examined.

RESULTS

The majority of these reviews omitted between one third and two thirds of the studies that could have been eligible for inclusion at the time they conducted the review. Methodologic information on how the review was conducted was not always provided. Furthermore, in some cases results of a study were reported incorrectly, or physical environmental aspects were conflated with social environmental or cognitive factors. Moreover, when results were reported incorrectly, physical environmental variables were almost always reported as significantly associated with physical activity, when these associations were nonsignificant, or were not assessed as part of the primary study.

CONCLUSIONS

Users of reviews in this field should be aware that there are significant methodologic variations among them, and that some reviews may include only a sample of the relevant primary studies. However, this is difficult to determine given the frequent incompleteness of review method reporting. Greater standardization in the reporting of review methods may assist with future efforts to summarize studies of the relationship between physical environments and physical activity.

Five-year predictors of physical activity decline among adults in low-income communities: a prospective study

BACKGROUND

Obesity in North America is now endemic, and increased understanding of the determinants of physical inactivity is critical. This analysis identified predictors of declines in physical activity over 5 years among adults in low-income, inner-city neighbourhoods.

METHODS

Data on leisure time physical activity were collected in telephone interviews in 1992 and 1997 from 765 adults (47% of baseline respondents), as part of the evaluation of a community-based cardiovascular disease risk reduction program.

RESULTS

One-third of 527 participants who were physically active at baseline, were inactive in 1997. Predictors of becoming inactive included female sex (OR = 1.63 95% CI (1.09, 2.43)), older age (1.02 (1.01, 1.04)), higher BMI (1.57 (1.03, 2.40)), poor self-rated health (1.39 (1.05, 1.84)), lower self-efficacy for physical activity (1.46 (1.00, 2.14)), and not using a neighborhood facility for physical activity (1.61 (1.02, 2.14)).

CONCLUSION

These results highlight the fact that a variety of variables play a role in determining activity level, from demographic variables such as age and sex, to psychosocial and environmental variables. In addition, these results highlight the important role that other health-related variables may play in predicting physical activity level, in particular the observed association between baseline BMI and the increased risk of becoming inactive over time. Lastly, these results demonstrate the need for multi-component interventions in low-income communities, which target a range of issues, from psychosocial factors, to features of the physical environment.

Effects of a CHANGE intervention to increase exercise maintenance following cardiac events

BACKGROUND

Despite participation in a cardiac rehabilitation program, there is a downward trajectory of exercise participation during the year following a cardiac event.

PURPOSE

The purpose of this study was to test the effectiveness of CHANGE (Change Habits by Applying New Goals and Experiences), a lifestyle modification program designed to increase exercise maintenance in the year following a cardiac rehabilitation program. The CHANGE intervention consists of 5 small-group cognitive-behavioral change counseling sessions in which participants are taught self-efficacy enhancement, problem-solving skills, and relapse prevention strategies to address exercise maintenance problems.

METHOD

Participants (N = 250) were randomly assigned to the CHANGE intervention (supplemental to usual care) or a usual-care-only group. Exercise was measured using portable wristwatch heart rate monitors worn during exercise for 1 year. Cox proportional hazards regression was used to determine differences in exercise over the study year between the study groups.

RESULTS

Participants in the usual-care group were 76% more likely than those in the CHANGE group to stop exercising during the year following a cardiac rehabilitation program (hazard ratio = 1.76, 95% confidence interval = 1.08-2.86, p = .02) when adjusting for the significant covariates race, gender, comorbidity, muscle and joint pain, and baseline motivation. Most participants, however, had less than recommended levels of exercise amount and intensity.

CONCLUSIONS

Counseling interventions that use contemporary behavior change strategies, such as the CHANGE intervention, can reduce the number of individuals who do not exercise following cardiac events.

Enhancing theoretical fidelity: an e-mail-based walking program demonstration

PURPOSE

To examine the extent to which theoretical fidelity, or precision in replicating theory-based recommendations, influenced the effectiveness of two walking programs based on social cognitive theory (SCT).

DESIGN

Two-group randomized controlled trial.

SETTING

College town in Virginia.

SUBJECTS

Sixty-one sedentary adult women.

INTERVENTION

Two 12-week e-mail-based walking programs were compared. The high fidelity program was designed to more precisely follow SCT recommendations for operationalizing mastery procedures than the low fidelity program, which was designed to simulate how mastery procedures were operationalized in most existing SCT-based physical activity programs. Treatment contact and walking prescription were controlled across groups.

MEASURES

The 1-mile walk test of physical fitness and SCT measures were completed at baseline and posttest. Self-reported walking quantity was assessed at baseline, posttest, and 1-year follow-up. Walking logs were completed during the program. Process evaluation measures were completed at posttest.

RESULTS

Fifty women completed the study. The high fidelity group improved more than twice as much as the low fidelity group on 1-mile walk test time (86 vs. 32 seconds, p < .05), goal setting (p < .05), and positive outcome expectations (p < .05) and reported greater program satisfaction (p < .01).

CONCLUSION

Theoretical fidelity could advance the quality of physical activity interventions, which have often shown small effects.

Concepts guiding the study of the impact of the built environment on physical activity for older adults: a review of the literature

OBJECTIVE

To identify theoretical models and key concepts used to predict the association between built environment and seniors' physical activity on the basis of a comprehensive review of the published literature.

DATA SOURCE

Computer searches of Medline (1966-2002), PubMed (1966-2002), and Academic Search Elite (1966-2002) were conducted, and 27 English-language articles were found. Search terms included built environment, physical activity, exercise, walking, neighborhood, urban design, seniors, aging, aging in place, and physical environment.

STUDY INCLUSION AND EXCLUSION CRITERIA

The primary inclusion criterion included the relation between the built environment and the physical activity among seniors living in neighborhoods. Studies assessing physical activity or overall health of a community-based population were included if underlying theoretical models and concepts were applicable to a senior population. Studies solely assessing social or psychosocial characteristics of place were excluded, as were review articles.

DATA EXTRACTION

Extracted data included theoretical model, aspect of built environment studied, methods, and outcomes.

DATA SYNTHESIS

Tables present key definitions and summarize information from empirical studies.

RESULTS

Twenty-seven articles that focused on the environment-behavior relation in neighborhoods, six specific to seniors, were found. This area of research is in its infancy, and inconsistent findings reflect difficulties in measurement of the built environment.

CONCLUSIONS

The relation between the built environment and the physical activity among seniors has been the subject of a limited number of studies. The choice of theoretical model drives the selection of concepts and variables considered. Safety, microscale urban design elements, aesthetics, and convenience of facilities are consistently studied across models. Few validated instruments have been developed and tested to measure neighborhood built environment.

Understanding environmental influences on walking; Review and research agenda

BACKGROUND

Understanding how environmental attributes can influence particular physical activity behaviors is a public health research priority. Walking is the most common physical activity behavior of adults; environmental innovations may be able to influence rates of participation.

METHOD

Review of studies on relationships of objectively assessed and perceived environmental attributes with walking. Associations with environmental attributes were examined separately for exercise and recreational walking, walking to get to and from places, and total walking.

RESULTS

Eighteen studies were identified. Aesthetic attributes, convenience of facilities for walking (sidewalks, trails); accessibility of destinations (stores, park, beach); and perceptions about traffic and busy roads were found to be associated with walking for particular purposes. Attributes associated with walking for exercise were different from those associated with walking to get to and from places.

CONCLUSIONS

While few studies have examined specific environment-walking relationships, early evidence is promising. Key elements of the research agenda are developing reliable and valid measures of environmental attributes and walking behaviors, determining whether environment-behavior relationships are causal, and developing theoretical models that account for environmental influences and their interactions with other determinants.

Associations of perceived social and physical environmental supports with physical activity and walking behavior

We evaluated perceived social and environmental supports for physical activity and walking using multivariable modeling. Perceptions were obtained on a sample of households in a southeastern county. Respondents were classified according to physical activity levels and walking behaviors. Respondents who had good street lighting; trusted their neighbors; and used private recreational facilities, parks, playgrounds, and sports fields were more likely to be regularly active. Perceiving neighbors as being active, having access to sidewalks, and using malls were associated with regular walking.

Changes in neighborhood walking are related to changes in perceptions of environmental attributes

BACKGROUND

Several studies have found significant cross-sectional associations of perceived environmental attributes with physical activity behaviors. Prospective relations with environmental factors have been examined for vigorous activity, but not for the moderate-intensity activities that environmental and policy initiatives are being designed to influence.

PURPOSE

To examine prospective associations of changes in perceptions of local environmental attributes with changes in neighborhood walking.

METHODS

Baseline and 10-week follow-up telephone interviews with 512 adults (49% men).

RESULTS

Men who reported positive changes in aesthetics and convenience were twice as likely to increase their walking. Women who reported positive changes in convenience were more than twice as likely to have increased their walking. There were contrasting findings for men and women who reported traffic as less of a problem: Men were 61% less likely to have increased walking; however, women were 76% more likely to have done so.

CONCLUSIONS

Further studies are needed to determine the possibly causal nature of such environment-behavior relations and to elucidate relevant gender differences. Such evidence will provide underpinnings for public health initiatives to increase participation in physical activity.