Associations of physical activity with neighborhood environments and transportation modes in older Japanese adults

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

OBJECTIVE

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

DATA SOURCES

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

STUDY SECTION

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

DATA EXTRACTION

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

DATA SYNTHESIS

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

CONCLUSIONS

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

Systematic and meta-based evaluation of the relationship between the built environment and physical activity behaviors among older adults

Objectives

Existing assertions about the relationship between various factors of the built environment and physical activity behaviors are inconsistent and warrant further exploration and analysis.

Methods

This study systematically searched PubMed, Embase, Web of Science, Scopus, the Cochrane Library and Google Scholar for the effect of the built environment on the physical activity behaviors of older adults. R software was used to calculate the meta-estimated odds ratio with a 95% confidence interval. Simultaneously, the quality of included studies was evaluated using an observational study quality evaluation standard recommended by American health care quality and research institutions.

Results

A total of 16 original researches were included in this meta-analysis and eight factors of the built environment were evaluated. These factors which ranked from high to low according to their impact were traffic safety (OR = 1.58, 95% CI [1.14-2.20]), destination accessibility (OR = 1.24, 95% CI [1.06-1.44]), aesthetics of sports venues (OR = 1.21, 95% CI [1.07-1.37]), virescence of sports venues (OR = 1.14, 95% CI [1.06-1.23]), building density (OR = 1.07, 95% CI [1.02-1.13]). Additionally, it seemed that there was no potential association between mixed land use (OR = 1.01, 95% CI [0.92-1.10]), the quality of pedestrian facilities (OR = 1.00, 95% CI [0.92-1.08]) or commercial facilities (OR = 0.94, 95% CI [0.88-1.00]) and physical activity behaviors of older adults.

Conclusions

The built environment has been found to exhibit a significant relationship with the physical activity behaviors of older adults. It is proposed that factors such as traffic safety, destination accessibility, aesthetics of sports venues, virescence of sports venues, and building density be given more consideration when aiming to promote physical activity levels among older adults.

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

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

Differences in the Correlation between the Built Environment and Walking, Moderate, and Vigorous Physical Activity among the Elderly in Low- and High-Income Areas

Studies have proved that activity and fitness behaviors are closely related to the quality of life and health status of the elderly. However, different intensities of physical activity (PA)—walking, moderate PA, and vigorous PA—have different correlations with the built environment (BE). This study combines the high and low socioeconomic status (SES) of Guangzhou to establish two types of BE models. The physical activity time of 600 elderly people was collected from questionnaires. Through ArcGIS software, 300 m, 500 m, 800 m, and 1000 m buffer zones were identified, and the land use diversity, street design, population density, distance to destination, distance to public transportation—the five Ds of the BE—were measured. SPSS software was adopted to analyze the correlation between the BE and PA. Results: The PA of people living in low-SES areas was more dependent on the BE, whereas the correlation may be limited in high SES areas. Moreover, in low SES areas, walking was negatively correlated with street connectivity; moderate PA was positively correlated with street connectivity and the shortest distance to the subway station, but negatively correlated with the density of entertainment points of interest (POIs). Studying the relevant factors of the environment can propose better strategies to improve the initiative of the elderly to engage in PA.

The Development of the Psychological Determinants of Exercise Questionnaire for Japanese Older Adults: A Questionnaire Based Upon the Theoretical Domains Framework

Japan has become a super-aged society. To overcome the negative implications of this, practitioners are increasingly using exercise-based interventions to reduce the requirement for long-term care among Japanese older adults. However, no comprehensive means of assessing the wide range of exercise behavioral determinants exists for this population. Thus, the principle aim of this study was to develop a questionnaire based upon the theoretical domains framework-a framework that has synthesized a wide range of behavior change theories. Completed responses were received from 1,000 Japanese older adults who resided in the Kansai area of Japan. Findings were suggestive of good reliability and validity for seven unique psychological determinants of exercise. This study was the first to provide a measurement tool related to a distinct range of psychological determinants of exercise among Japanese older adults.

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.

Influence of Neighborhood Characteristics on Physical Activity, Health, and Quality of Life of Older Adults: A Path Analysis

Background: As life expectancy and health expenditure consumed by older people increase, maintaining a better health and quality of life for older adults has become an important social issue. Research indicates that physical activity may help address this challenge. Moreover, it is believed that improved quality of life and health benefits from physical activity can be achieved through interventions in the neighborhood environments. However, existing knowledge has often been based on bivariate relationships between these factors, and few studies have formally examined the extent to which any association between neighborhood environments, health, and quality of life may be mediated by the level of physical activity. This paper aims to investigate the direct and indirect influence of neighborhood characteristics on the health and quality of life of older adults, taking into account physical activity behavior and socio-demographic characteristics in a more comprehensive framework. Methods: Data were collected using a survey among 363 older adults aged 60 years and over in China. A path analysis was used that derives all direct and indirect relationships between the variables. Results: Leisure-time physical activity levels played a mediating role in the relation between social capital and health as well as quality of life. Moreover, the study confirmed direct relationships between neighborhood characteristics such as neighborhood aesthetics and traffic safety and health as well as quality of life. However, the effect of neighborhood characteristics on health and quality of life through transport-related physical activity levels was not found. Conclusions: Leisure-time physical activity instead of transport-related physical activity should be considered a priority when developing interventions aiming to promote healthy aging. Additionally, neighborhood characteristics are important in promoting healthy aging, even though they have no or less impacts on older adults' health and quality of life through physical activity.

Older Adults' Choice of Patterns of Outdoor Physical Activity Duration: A Mixed Multinomial Logit Model

Outdoor physical activity duration is a key component of outdoor physical activity behavior of older adults, and therefore, an important determinant of their total physical activity levels. In order to develop a successful outdoor physical activity program, it is important to identify any heterogeneity in preferences for outdoor physical activity duration patterns among older adults. In addition, more insight is needed in the influence of environmental characteristics on duration choice for creating supportive neighborhood environments matching individuals’ preferences. To this end, a mixed multinomial logit model is estimated based on one-week data collected among 336 respondents aged 60 or over in 2017 in Dalian, China. The present model formulation accounts for heterogeneity in individuals’ preferences and allows for the analysis of substitution and complementary relationships between the different patterns of outdoor physical activity duration. Results indicate that older adults vary significantly in their preferences for each outdoor physical activity duration pattern. Moreover, short walking duration, short exercise duration and medium exercise duration are substitutes for medium walking duration while short walking duration and short exercise duration are complements for medium exercise duration in terms of individuals’ outdoor physical activity duration preferences. In addition, we find that distance to the nearest park, footpath conditions and neighborhood aesthetics are associated with older adults’ outdoor physical activity duration choice.

Association between the type of physical activity and metabolic syndrome in middle-aged and older adult residents of a semi-mountainous area in Japan

BACKGROUND

Physical activity is reported to prevent metabolic syndrome. However, it is unclear whether exercise or daily physical activity is more beneficial for residents of semi-mountainous areas. This study aimed to identify whether daily physical activity is more beneficial than exercise for the prevention of metabolic syndrome among middle-aged and older residents in semi-mountainous areas.

METHODS

We analyzed secondary data of 636 people who underwent a specific health checkup in a semi-mountainous area of Japan. Physical activity was classified into four types: inactivity (I-type; without exercise and without daily physical activity), only exercise (E-type; with exercise and without daily physical activity), only daily physical activity (D-type; without exercise and with daily physical activity), and full physical activity type (F-type; with exercise and with daily physical activity). We compared the means of risk factors for metabolic syndrome by these four types, followed by logistic regression analysis, to identify whether and to what extent the D-type was less likely to have metabolic syndrome than the E-type.

RESULTS

The prevalence of metabolic syndrome was 28.5% (men 45.7%, women 15.8%). The proportions of men with exercise and daily physical activity were 38.7% and 52.8%, respectively. For women, the proportions were 33.0% and 47.1%, respectively. In women, the D-type had the significantly lowest BMI, smallest waist circumference, highest HDL-C, and lowest prevalence of metabolic syndrome of the four types; the same was not observed in men. Additionally, D-type activity was more strongly associated with a reduced risk of metabolic syndrome than E-type activity in women (adjusted odds ratio 0.24; 95% confidence interval 0.06-0.85, P = 0.028).

CONCLUSIONS

Compared to middle-aged and older women residents with exercise in a semi-mountainous area of Japan, those with daily physical activity may effectively prevent metabolic syndrome.

Neighborhood Environmental Factors and Physical Activity Status among Rural Older Adults in Japan

(1) Background: Although several neighborhood environmental factors have been identified to be associated with older adults’ physical activity, little research has been done in rural areas where the population is aging. This study aimed to investigate neighborhood environmental factors and the longitudinal change of physical activity status among rural older adults in Japan. (2) Methods: The study included 2211 older adults, aged over 60 years, residing in three municipalities in Shimane prefecture and participating at least twice in annual health checkups between 2010 and 2019. Physical activity was identified based on self-report. Hilliness, bus stop density, intersection density, residential density, and distance to a community center were calculated for each subject. Hazard ratios for the incidence of physical inactivity were estimated using Cox proportional hazards models. (3) Results: We found that 994 (45%) of the study subjects became physically inactive during the follow-up. Those living far from a community center had a lower risk of becoming physically inactive compared to those living close to a community center. When the analysis was stratified by residential municipality, this association remained in Ohnan town. Those living in hilly areas had a higher risk of becoming physically inactive in Okinoshima town. (4) Conclusions: The impact of neighborhood environmental factors on older adults’ physical activity status might differ by region possibly due to different terrain and local lifestyles.

Association of Perceived Environment and Physical Activity in Older Adults After the Great East Japan Earthquake

The aim of this study was to examine the association between perceived environment and physical activity among older adults in Fukushima Prefecture after the 2011 Great East Japan Earthquake and the impact of evacuation. Questionnaires were distributed to individuals aged 65 years and older from October to November 2018. Perceived environment was assessed using a five-item questionnaire on home fitness equipment, access to facilities, neighborhood safety, enjoyable scenery, and frequency of observing others exercising. Physical activity, assessed via the Physical Activity Questionnaire for Elderly Japanese, was segregated into levels based on the median score. Data from 249 participants (74.2 ± 6.9 years) were analyzed. A logistic regression analysis found that the unenjoyable Scenery × Residing in restoration public housing interaction (odds ratio = 3.87, 95% confidence interval = [1.20, 12.46]) was significant. The association between enjoyable scenery and physical activity varied according to whether the participants had experienced evacuation or not.

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

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

Association Between Public Transportation Use and Loneliness Among Urban Elderly People Who Stop Driving

Aim: To examine the association between public transportation use and loneliness in urban elderly who stop driving. Methods: In this cross-sectional study, we assessed 31 community-dwelling older adults who had stopped driving. Public transportation use was assessed by using frequency and divided into two groups. The users group was participants who used public transportation more than once a week and the nonusers group was participants who used public transportation less than once a week. Loneliness was measured using the Japanese version of the UCLA Loneliness Scale version 3 (UCLA.LS.ver3), with a higher score indicating greater loneliness. The independent t test was used to compare the UCLA.LS.ver3 scores between users and nonusers group. A multiple linear regression model was used with the UCLA.LS.ver3 score as the objective variable and public transportation use as the explanatory variable. Results: The UCLA.LS.ver3 score was significantly higher in the nonusers group than in the users group (nonusers group: 12.7 ± 1.9; users group: 10.1 ± 2.9, p = .017). After adjustments, public transportation use was significantly associated with lower loneliness (β = −2.55, p = .029). Conclusion: Public transportation use might have important role to prevent loneliness in older adults who stop driving.

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

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

Psychological and Environmental Correlates of Moderate-to-Vigorous Physical Activity and Step Counts Among Older Adults With Cognitive Decline

Promoting physical activity (PA) among older adults with cognitive decline is important for maintaining and improving their health. Identifying psychological and environmental PA correlates in this population can help develop effective strategies for PA promotion. Since past findings with healthy older adults may not generalize to those with cognitive decline, this study offers data on how self-efficacy, self-regulation, and social-environmental factors were associated with PA among a group of older adults with cognitive decline. We report secondary analysis of baseline data from a randomized control study of 262 older participants (M = 76.2 years) who showed a decline in global cognitive function as defined by Mini-Mental State Examination scores between 21 and 24. The participants' PA was measured by an accelerometer, and participants completed questionnaires measuring self-efficacy, self-regulation, social support, social network, and demographic variables. In this study, we evaluated the participants' neighborhood environment with a geographic information system and found through stepwise multiple regression analyses that self-efficacy, gender, and age were associated with PA variables, while self-regulation and environmental factors were not. Thus, perceived self-efficacy was an important psychological correlate of PA in this group of older adults with cognitive decline. PA promotion interventions for this population should attend to self-efficacy, gender, and age.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO 2016:CRD42016051180.

Perceived Neighborhood Safety, Social Cohesion, and Psychological Health of Older Adults

Purpose of the Study

We aimed to investigate the interactive effects of perceived neighborhood safety and social cohesion on the psychological health of older adults with and without functional impairments.

Design and Methods

This cross-sectional study included 13,897 community-dwelling older adults (aged 65 years and older) from the 2011-2012 California Health Interview Survey (CHIS). Hypotheses were tested using weighted moderated ordinary least squared regression analysis.

Results

Perceived neighborhood safety was significantly associated with psychological health regardless of respondents' physical functioning, although the effect was greater among older adults with functional limitations. Perceived social cohesion, however, was only significantly related to psychological health among those with functional limitations. Among physically impaired respondents, social cohesion buffered the ill-effect of an unsafe neighborhood on psychological health.

Implications

Findings suggest that efforts to promote perceived neighborhood safety and social cohesion are essential to the well-being of older adults. Special attention should be paid to older adults with functional limitations, who appear to be more vulnerable to the negative effects of neighborhood environments.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Neighborhood safety factors associated with older adults' health-related outcomes: A systematic literature review

RATIONALE

Neighborhood safety is important for older adults' health and wellbeing, but there has not been a synthesis in the literature of what is currently known about this construct.

OBJECTIVES

This systematic literature review, following the PRISMA guidelines, focuses on identifying neighborhood safety factors associated with health-related outcomes and behaviors of older adults in the U.S.

METHODS

A search was conducted in 2014 via Academic Search Complete, CINAHL, Embase, MEDLINE, SportDis, and Transportation Databases. Based on our inclusion and exclusion criteria, we identified thirty-two articles for review.

RESULTS

Sixteen studies examined health outcomes such as health status, mental health, physical function, morbidity/mortality, and obesity; the other sixteen studies focused on health behaviors, such as physical activity and walking. Four domains of neighborhood safety were identified: overall/general neighborhood safety; crime-related safety; traffic-related safety; and proxies for safety (e.g., vandalism, graffiti). Overall/general neighborhood safety appeared most relevant to mental health and physical function. Traffic-related safety was most pertinent to physical activity, while crime-related safety was more consistently associated with mental health and walking. While all safety variables were significantly associated with mental health, no significant associations were found for obesity. We also found that specific measures or constructs of safety were not applied consistently across the examined studies, making it difficult to compare the results.

CONCLUSION

This review identified several important gaps in the existing studies dealing with neighborhood safety-health relationships among older adults. Further studies are needed that examine the different roles of multidimensional neighborhood safety in promoting the community health, not only in the U.S., but globally.

Exploring Associations Between Perceived Measures of the Environment and Walking Among Brazilian Older Adults

OBJECTIVE

To investigate the associations between perceived environment features and walking in older adults.

METHOD

A cross-sectional population-based study was performed in Florianopolis, Brazil, including 1,705 older adults (60+ years). Walking was measured by the International Physical Activity Questionnaire (IPAQ), and perceived environment was assessed through the Neighborhood Environment Walkability Scale. We conducted a multinomial logistic regression to examine the association between perceived environment and walking.

RESULTS

The presence of sidewalks was related to both walking for transportation and for leisure. Existence of crosswalks in the neighborhood, safety during the day, presence of street lighting, recreational facilities, and having dog were significant predictors of walking for transportation. Safety during the day and social support were significantly associated with walking for leisure.

DISCUSSION

The perceived environment may affect walking for specific purposes among older adults. Investments in the environment may increase physical activity levels of older adults in Brazil.

Perceived and Objective Measures of Neighborhood Walkability and Physical Activity among Adults in Japan: A Multilevel Analysis of a Nationally Representative Sample

Although associations between a person’s neighborhood and their health have been studied internationally, most studies have been limited to a few cities or towns. Therefore, we used a nationally representative sample to explore whether perceived and objective neighborhood walkability was associated with the physical activity of residents. Data were analyzed from the Japanese General Social Surveys of 2010 (n = 2395; 1114 men and 1281 women). Perceived walkability was scored using factor analysis for the respondents’ perceptions of neighborhood conditions, while objective walkability was measured using the geographic information system approach. Finally, multilevel logistic regression analysis was performed to examine whether neighborhood walkability was associated with the frequency of leisure-time physical activity (LTPA) among respondents. We found that perceived walkability was positively associated with the frequency of LTPA (odds ratio of the highest quartile was 1.53 (1.14–2.05) compared with the lowest quartile); however, objective walkability showed no association. When stratified by gender, an association between perceived walkability and LTPA was observed among women, but only a marginally significant association was present between objective walkability and LTPA among men. We conclude that the association between neighborhood walkability and LTPA can be partially generalized across Japan.

The relationship between the built environment and habitual levels of physical activity in South African older adults: a pilot study

BACKGROUND

Previous research has shown that the built environment plays a role in habitual levels of physical activity (PA), however much of this research has been conducted in adults and higher income countries. The aim of this pilot study was to examine the strength of association between the built environment and PA in South African older adults.

METHODS

Participants were recruited (n = 44, mean age 65 ± 8.5 years) from two suburbs, representing either a high socioeconomic (HSA) or low socioeconomic area (LSA). Self-reported PA, and subjective assessments of neighborhood walkability (Neighborhood Environment Walkability Scale, NEWS) was measured. Participants wore Actigraph GT3x accelerometers to objectively quantify PA.

RESULTS

HSA participants reported significantly more leisure-time and less transport PA. Objectively measured and self-reported MVPA was significantly higher in HSA participants. NEWS 'Land-use Mix' was negatively associated with leisure-time MVPA, (r(2) = 0.20; p < 0.02). In addition, neighborhood aesthetics was positively associated with leisure-time physical activity (r(2) = 0.33; p = 0.02). 'Safety from traffic' was inversely associated with travel-related PA (r(2) = 0.14, p = 0.01). None of the other NEWS scores were associated with PA for the total group.

CONCLUSION

Leisure-time and transport-related PA was influenced by socio-economic status. Attributes of the perceived built environment associated with leisure-time and total MVPA in older South Africa adults were different in low- and high- income settings.

Are park proximity and park features related to park use and park-based physical activity among adults? Variations by multiple socio-demographic characteristics

Background

Parks are valuable resources for physical activity (PA) given their widespread availability and low cost to maintain and use. Both proximity to parks and the availability of particular features are important correlates of PA. However, few studies have explored multiple measures of proximity simultaneously or the specific facilities associated with park use and park-based PA among adults, let alone differences across socio-demographic characteristics. The purpose of this study was to examine associations between park proximity and park facilities and adults’ park use and park-based PA, while also exploring differences by gender, age, race, and income.

Methods

Data on monthly park use and weekly amount of PA undertaken in parks were collected via a mail survey of adults from randomly-selected households (n = 893) in Kansas City, Missouri (KCMO) in 2010–2011. Three measures of park proximity were calculated within 1 mile of participating households: distance to the closest park, number of parks, and total park area. All parks in KCMO were audited using the Community Park Audit Tool to determine the availability of 14 park facilities within 1 mile of each participant (e.g., trail, playground, tennis court). Multilevel logistic regression was used to examine the relationship between each of park use and park-based PA and 1) three measures of park proximity, and 2) the availability of 14 park facilities within 1 mile of participants. Separate analyses were conducted by gender, age, race, and income, while controlling for all socio-demographic characteristics and BMI.

Results

Across all sub-samples, distance to the closest park was not significantly related to either park use or park-based PA. However, numerous significant associations were found for the relationship of number of parks and amount of park space within 1 mile with both outcomes. As well, diverse facilities were associated with park use and park-based PA. For both park proximity and facilities, the significant relationships varied widely across gender, age, race, and income groups.

Conclusions

Both park proximity and park facilities are related to park use and park-based PA. Understanding how such associations vary across demographic groups is important in planning for activity-friendly parks that are responsive to the needs of neighborhood residents.

Association between difficulty initiating sleep in older adults and the combination of leisure-time physical activity and consumption of milk and milk products: a cross-sectional study

Background

Research has shown that engaging in leisure-time physical activity (LTPA) and consuming dairy foods can lead to better sleep. Combining these two non-invasive prescriptions may be more effective for helping people fall asleep. This study investigates whether participating in LTPA in conjunction with consuming milk and milk products has a beneficial association with difficulty initiating sleep (DIS) among older adults.

Methods

The present study looked at 421 community-dwelling older people aged 65 years and older living in Ibaraki prefecture, Japan (mean age 74.9 ± 5.5 years, male 43.7%). We measured LTPA and sleep latency with the Physical Activity Scale for the Elderly and the Pittsburgh Sleep Quality Index, respectively. Participants who needed 30 minutes or more to fall asleep were defined as having DIS. We assessed dairy consumption as participants’ habitual intake of milk, yogurt and cheese.

Results

After adjusting for covariates, participants who engaged in sufficient levels of LTPA as well as consumed milk (OR = 0.27, 95% CI = 0.10-0.73) or cheese (OR = 0.34, 95% CI = 0.14-0.85) were less likely to complain of DIS compared with people who neither engaged in LTPA nor ingested milk or cheese.

Conclusions

Our findings suggest that the combination of engaging in LTPA and consuming milk or cheese is necessary as a prescription to improve falling asleep for older adults suffering from DIS. Additionally, engaging in LTPA along with dairy consumption may effectively improve a problem with falling asleep.

Physical activity-friendly neighbourhood among older adults from a medium size urban setting in Southern Europe

OBJECTIVE

In this cross-sectional study, we examined the relationship between socio-environmental characteristics of neighborhood of residence and the frequency of leisure-time physical activity (LTPA) among older adults from Porto (Portugal).

METHOD

Data from EpiPorto - a prospective adult cohort study from Porto (Portugal) - were used. Only adults aged ≥ 65 at baseline (1999-2003) were included (n=580). We used a Geographic Information System to objectively measure the neighborhood characteristics and Generalized Additive Models to estimate their effect on participation in LTPA (none vs. some reported) and frequency of LTPA (min/day).

RESULTS

62% of the participants reported no LTPA. Active elderly spent on average 38 (women) and 67 (men) minutes per day exercising. Neighborhood characteristics were unrelated to whether older people exercised or not. However, among active individuals, distance to the nearest destination (β=-0.154, p=0.016), in women, and distance to the nearest park, in men (-0.030, 0.050), were predictors of LTPA frequency.

CONCLUSION

There was almost no association between neighborhood characteristics and whether older adults engaged in LTPA or not, but among those that did engage, neighborhood characteristics were associated with increased frequency of LTPA. The promotion of well distributed destinations and parks might improve physical activity levels among the elderly.

Association between out-of-home trips and older adults' functional fitness

AIM

To explore the purposes of older adults' out-of-home trips, and to investigate the association between the frequency of these trips and older adults' functional fitness.

METHODS

A total of 412 older adults in Taiwan were recruited from 2009 to 2010. Participants were asked to fill out questionnaires on out-of-home trips, and trained volunteers assessed the functional fitness of respondents using objective measures. Descriptive statistics, univariate analysis, multivariate regression analysis and canonical correlation analysis were then used to analyze the resulting data.

RESULTS

Results show that exercise is most frequently the purpose for going out at least once a day, and that parks are the most preferred places to visit. Sex and age are the significant variables explaining variance in older adults' flexibility and physical power, respectively. Canonical correlation analysis showed one significant variate pair (R(2)(c)  = 8.80) between the frequency of out-of-home trips (engaging in exercise and participating in religious activities) and fitness measure test scores including the chair stand, arm curl, 2-min step, and 8-foot up-and-go. The relationship did not exist for the back scratch, nor chair sit-and-reach test scores.

CONCLUSION

The present study provides empirical and objective evidence on older adults' purposes for taking out-of-home trips, and for the positive association between the frequency of these trips, and the muscular strength and cardiovascular endurance, but not flexibility, of older adults.

Age and gender differences in correlations of leisure-time, household, and work-related physical activity with physical performance in older Japanese adults

AIM

This study aimed to compare relationships of leisure-time, household, and work-related physical activity (PA) with physical performance by age and gender in older Japanese adults.

METHODS

This cross-sectional study included 525 community-dwelling older adults (73.3 ± 5.2 years) recruited in 2009-2011 in Kasama City, rural Japan. We used the Physical Activity Scale for the Elderly to assess PA variables. Physical performance was evaluated by 11 performance tests: grip strength, single-leg balance, functional reach, sit-and-reach, standing time from long sitting position, sit-to-stand, timed up and go, habitual walk, hand working, and simple and choice reaction times.

RESULTS

After adjusting for potential confounders, leisure-time PA in young-old (≤ 74 years) men correlated significantly with eight performance tests (absolute value of Spearman's partial rank correlation coefficient: r = 0.18-0.39), whereas in old-old (≥ 75 years) men it correlated with three performance tests (r = 0.20-0.23). Although leisure-time PA correlated with six performance tests (r = 0.19-0.22) in young-old women, there were no significant correlations between leisure-time PA and performance tests in old-old women. Household PA of young-old men (r = 0.20-0.23) and old-old women (r = 0.26-0.34) correlated with four performance tests. In old-old men and young-old women, no significant correlation was found between household PA and performance tests. Work-related PA did not relate significantly to any performance tests in any groups.

CONCLUSION

This study showed that leisure-time PA is related to physical performance, especially in young-old men and women, and household PA is especially related in young-old men and old-old women. Our findings suggest that supporting strategies for maintaining physical functions would differ by gender and age.

Objectively-measured neighborhood environments and leisure-time physical activity in Chinese urban elders

OBJECTIVE

The built environment may impact on elders' ability to engage in leisure-time physical activity (LTPA). Environmental correlates of LTPA in older Chinese residents of ultra-dense cities are unknown. The main aim of this study was to identify the aspects of the neighborhood environment associated with LTPA of Chinese elders residing in an ultra-dense city and able to walk unassisted.

METHODS

This study was conducted in Hong Kong in 2007-2008. We investigated the relationships of neighborhood environmental attributes (environmental audits) with LTPA (interviewer-administered questionnaire) in 484 elders able to walk unassisted and living in 32 neighborhoods stratified by socio-economic status and walkability.

RESULTS

The amount of recreational walking was positively related to the availability of parks (e(b) = 1.03; 95% CI = 1.02, 1.05) and several other environmental attributes. The odds of non-participation in other LTPA (OLTPA) were related to availability of recreational facilities (ORs from 0.96 to 0.99) and infrastructure, aesthetics, and safety aspects of the neighborhood. These aspects also moderated the relationships of recreational facilities with non-participation in OLTPA, being negative only in safe, aesthetically-pleasing locations with good infrastructure.

CONCLUSIONS

Safe, aesthetically-pleasing, low-pollution neighborhoods with easy access to recreational and public facilities may facilitate the engagement in LTPA in Chinese urban elders able to walk unassisted.