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Ringsten M, Ivanic B, Iwarsson S, Lexell EM. Interventions to improve outdoor mobility among people living with disabilities: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1407. [PMID: 38882933 PMCID: PMC11177337 DOI: 10.1002/cl2.1407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 06/18/2024]
Abstract
Background Around 15% of the global population live with some form of disabilities and experience worse health outcomes, less participation in the community and are part of fewer activities outside the home. Outdoor mobility interventions aim to improve the ability to move, travel and orient outside the home and could influence the number of activities outside the home, participation and quality of life. However, outdoor mobility interventions may also lead to harm like falls or injuries or have unforeseen effects which could lead to mortality or hospitalization. Objectives To assess the efficacy of interventions aiming to improve outdoor mobility for adults living with disabilities and to explore if the efficacy varies between different conditions and different intervention components. Search Methods Standard, extensive Campbell search methods were used, including a total of 12 databases searched during January 2023, including trial registries. Selection Criteria Only randomized controlled trials were included, focusing on people living with disabilities, comparing interventions to improve outdoor mobility to control interventions as well as comparing different types of interventions to improve outdoor mobility. Data Collection and Analysis Standard methodological procedures expected by Campbell were used. The following important outcomes were 1. Activity outside the home; 2. Engagement in everyday life activities; 3. Participation; 4. Health-related Quality of Life; 5. Major harms; 6. Minor harms. The impact of the interventions was evaluated in the shorter (≤6 months) and longer term (≥7 months) after starting the intervention. Results are presented using risk ratios (RR), risk difference (RD), and standardized mean differences (SMD), with the associated confidence intervals (CI). The risk of bias 2-tool and the GRADE-framework were used to assess the certainty of the evidence. Main Results The screening comprised of 12.894 studies and included 22 studies involving 2.675 people living with disabilities and identified 12 ongoing studies. All reported outcomes except one (reported in one study, some concerns of bias) had overall high risk of bias. Thirteen studies were conducted in participants with disabilities due to stroke, five studies with older adults living with disabilities, two studies with wheelchair users, one study in participants with disabilities after a hip fracture, and one study in participants with cognitive impairments. Skill training interventions versus control interventions (16 studies) The evidence is very uncertain about the benefits and harms of skill training interventions versus control interventions not aimed to improve outdoor mobility among all people living with disabilities both in the shorter term (≤6 months) and longer term (≥7 months) for Activity outside the home; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. Skill training interventions may improve engagement in everyday life activities among people with disabilities in the shorter term (RR: 1.46; 95% CI: 1.16 to 1.84; I 2 = 7%; RD: 0.15; 95% CI: -0.02 to 0.32; I 2 = 71%; 692 participants; three studies; low certainty evidence), but the evidence is very uncertain in the longer term, based on very low certainty evidence. Subgroup analysis of skill training interventions among people living with disabilities due to cognitive impairments suggests that such interventions may improve activity outside the home in the shorter term (SMD: 0.44; 95% CI: 0.07 to 0.81; I 2 = NA; 118 participants; one study; low certainty evidence). Subgroup analysis of skill training interventions among people living with cognitive impairments suggests that such interventions may improve health-related quality of life in the shorter term (SMD: 0.49; 95% CI: 0.12 to 0.88; I 2 = NA; 118 participants; one study; low certainty evidence). Physical training interventions versus control interventions (five studies) The evidence is very uncertain about the benefits and harms of physical training interventions versus control interventions not aimed to improve outdoor mobility in the shorter term (≤6 months) and longer term (≥7 months) for: Engagement in everyday life activities; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. Physical training interventions may improve activity outside the home in the shorter (SMD: 0.35; 95% CI: 0.08 to 0.61; I 2 = NA; 228 participants; one study; low certainty evidence) and longer term (≥7 months) (SMD: 0.27; 95% CI: 0.00 to 0.54; I 2 = NA; 216 participants; one study; low certainty evidence). Comparison of different outdoor mobility interventions (one study) The evidence is very uncertain about the benefits and harms of outdoor mobility interventions of different lengths in the shorter term (≤6 months) and longer term (≥7 months) for Activity outside the home; Engagement in everyday life activities; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. No studies explored the efficacy of other types of interventions. Authors’ Conclusions Twenty-two studies of interventions to improve outdoor mobility for people living with disabilities were identified, but the evidence still remains uncertain about most benefits and harms of these interventions, both in the short- and long term. This is primarily related to risk of bias, small underpowered studies and limited reporting of important outcomes for people living with disabilities. For people with disabilities, skill training interventions may improve engagement in everyday life in the short term, and improve activity outside the home and health-related quality of life for people with cognitive impairments in the short term. Still, this is based on low certainty evidence from few studies and should be interpreted with caution. One study with low certainty evidence suggests that physical training interventions may improve activity outside the home in the short term. In addition, the effect sizes across all outcomes were considered small or trivial, and could be of limited relevance to people living with disabilities. The evidence is currently uncertain if there are interventions that can improve outdoor mobility for people with disabilities, and can improve other important outcomes, while avoiding harms. To guide decisions about the use of interventions to improve outdoor mobility, future studies should use more rigorous design and report important outcomes for people with disabilities to reduce the current uncertainty.
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Affiliation(s)
- Martin Ringsten
- Cochrane Sweden, Research and Development Skåne University Hospital Lund Sweden
- Department of Health Sciences Lund University Lund Sweden
| | | | | | - Eva Månsson Lexell
- Department of Health Sciences Lund University Lund Sweden
- Department of Neurology, Rehabilitation Medicine, Cognitive Medicine and Geriatrics Skåne University Hospital Lund-Malmö Sweden
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Tuomola EM, Keskinen KE, Viljanen A, Rantanen T, Portegijs E. Neighborhood Walkability, Walking Difficulties, and Participation in Leisure Activities Among Older People: A Cross-Sectional Study and 4-Year Follow-Up of a Subsample. J Aging Health 2024; 36:367-378. [PMID: 37482698 PMCID: PMC11025300 DOI: 10.1177/08982643231191444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Objectives: To study cross-sectional and longitudinal associations between objectively assessed neighborhood walkability, walking difficulties, and participation in leisure activities among older people. Methods: Self-reported 2 km walking difficulty (intact, modifications, difficulties) at baseline and participating in organized group, outdoor recreation and cultural activities at baseline and follow-up were studied in community-dwelling persons (N = 848) aged 75-90. A walkability index, calculated using a geographic information system, was categorized into tertiles (lowest, middle, highest). Results: Residence in the highest walkability areas was associated with higher participation in cultural activities and lower participation in outdoor recreation, while the latter was most frequently reported by residents in the lowest walkability areas. Those reporting no difficulties were more likely than those reporting difficulties to participate in all studied activities. Residence in the middle or highest walkability areas predicted higher participation in cultural activities at follow-up. Discussion: Older persons activity profiles associate with neighborhood walkability and walking difficulties.
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Affiliation(s)
- Essi-Mari Tuomola
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyvaskyla, Jyväskylä, Finland
| | - Kirsi E. Keskinen
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyvaskyla, Jyväskylä, Finland
| | - Anne Viljanen
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyvaskyla, Jyväskylä, Finland
| | - Taina Rantanen
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyvaskyla, Jyväskylä, Finland
| | - Erja Portegijs
- University Medical Center Groningen, Center for Human Movement Sciences, University of Groningen, Groningen, The Netherlands
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Song Y, Liu Y, Bai X, Yu H. Effects of neighborhood built environment on cognitive function in older adults: a systematic review. BMC Geriatr 2024; 24:194. [PMID: 38408919 PMCID: PMC10898015 DOI: 10.1186/s12877-024-04776-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 02/03/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND In the background of an aging population, the risk of cognitive impairment in the older population is prominent. Exposure to complex neighborhood built environments may be beneficial to the cognitive health of older adults, and the purpose of this study was to systematically review the scientific evidence on the effects of neighborhood built environments on cognitive function in older adults. METHODS Keywords and references were searched in Web of Science, Pubmed, PsycINFO, and MEDLINE. Studies examining the relationship between the built environment and cognitive function in older adults were included. The neighborhood built environment as an independent variable was classified according to seven aspects: density, design, diversity, destination accessibility, public transportation distance, blue/green space, and built environment quality. The cognitive function as the dependent variable was classified according to overall cognitive function, domain-specific cognitive function, and incidence of dementia. The quality of the included literature was assessed using the National Institutes of Health's Observational Cohort and Cross-Sectional Study Quality Assessment Tool. RESULTS A total of 56 studies were included that met the inclusion criteria, including 31 cross-sectional studies, 23 longitudinal studies, 1 cross-sectional study design combined with a case-control design, and 1 longitudinal study design combined with a case-control design. Most of the studies reviewed indicate that the built environment factors that were positively associated with cognitive function in older adults were population density, street connectivity, walkability, number of public transportation stops around the residence, land use mix, neighborhood resources, green space, and quality of the neighborhood built environment. Built environment factors that were negatively associated with cognitive function in older adults were street integration, distance from residence to main road. The relationship between residential density, destination accessibility, and blue space with cognitive function in older adults needs to be further explored. CONCLUSION Preliminary evidence suggests an association between the neighborhood built environment and cognitive function in older adults. The causal relationship between the built environment and cognitive function can be further explored in the future using standardized and combined subjective and objective assessment methods, and longitudinal or quasi-experimental study designs. For public health interventions on the cognitive health of older adults, it is recommended that relevant authorities include the neighborhood built environment in their intervention programs.
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Affiliation(s)
- Yiling Song
- Department of Physical Education, Tsinghua University, Beijing, 100084, China
| | - Yunxi Liu
- Graduate School of Commerce, Waseda University, Tokyo, 169-8050, Japan
| | - Xiaotian Bai
- Department of Physical Education, Tsinghua University, Beijing, 100084, China
| | - Hongjun Yu
- Department of Physical Education, Tsinghua University, Beijing, 100084, China.
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Kalu ME, Bello-Haas VD, Griffin M, Boamah S, Harris J, Zaide M, Rayner D, Khattab N, Abrahim S. A Scoping Review of Personal, Financial, and Environmental Determinants of Mobility Among Older Adults. Arch Phys Med Rehabil 2023; 104:2147-2168. [PMID: 37119957 DOI: 10.1016/j.apmr.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 05/01/2023]
Abstract
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.
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Affiliation(s)
- Michael E Kalu
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
| | - Vanina Dal Bello-Haas
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Meridith Griffin
- Department of Health, Aging & Society, Faculty of Social Science, McMaster University, Hamilton, Canada
| | - Sheila Boamah
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Jocelyn Harris
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Mashal Zaide
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Daniel Rayner
- Department of Health Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Nura Khattab
- Department of Kinesiology, Faculty of Sciences, McMaster University, Hamilton, Canada
| | - Salma Abrahim
- Department of Kinesiology, Faculty of Sciences, McMaster University, Hamilton, Canada
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Salvo D, Resendiz E, Stefancic A, Cabassa LJ. Examining Place-Based Neighborhood Factors in a Multisite Peer-Led Healthy Lifestyle Effectiveness Trial for People with Serious Mental Illness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095679. [PMID: 37174197 PMCID: PMC10178706 DOI: 10.3390/ijerph20095679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 05/15/2023]
Abstract
People with severe mental illness (SMI) experience significantly higher obesity-related comorbidities and premature mortality rates than healthy populations. The physical and social characteristics of neighborhoods where people with SMI reside can play an important role in promoting or hindering healthy eating and physical activity. However, this is seldom considered when designing and testing health behavior interventions for these populations. This study used baseline data from an obesity control trial for low-income, minority people with SMI to demonstrate the utility of assessing neighborhood- and city-level place-based factors within the context of lifestyle interventions. GIS was used to create a zip-code-level social and built environment geodatabase in New York City and Philadelphia, where the trial occurred. Chi-square and t-tests were used to assess differences in the spatial distribution of health-related built and social environment characteristics between and within cities and diet and physical activity outcomes. All types of neighborhood characteristics showed significant environmental differences between and within cities. Several neighborhood characteristics were associated with participants' baseline healthy eating and physical activity behaviors, emphasizing that place-based factors may moderate lifestyle interventions for SMI patients. Future behavioral interventions targeting place-dependent behaviors should be powered and designed to assess potential moderation by place-based factors.
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Affiliation(s)
- Deborah Salvo
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX 78712, USA
| | - Eugen Resendiz
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Ana Stefancic
- Department of Psychiatry, Columbia University, New York, NY 10032, USA
| | - Leopoldo J Cabassa
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA
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What happens behind doors? Exploring everyday indoor activities when ageing in place. J Aging Stud 2023; 64:101109. [PMID: 36868621 DOI: 10.1016/j.jaging.2023.101109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/13/2023] [Accepted: 01/23/2023] [Indexed: 02/05/2023]
Abstract
Engaging in social interaction and physical movement during everyday activities has a positive influence on wellbeing in later life. For older adults who age in place, the majority of activities occur indoors, yet studies typically focus on outdoors. Gender influences social and physical activities but is understudied in an ageing-in-place context. We aim to address these gaps by increasing insight into the indoor activities in later life, with a focus on gender differences in social interaction and physical movement. Through a mixed-methods approach, data were collected using global positioning system (GPS) trackers, pedometers and activity diaries. Twenty community-dwelling older adults (11 women and 9 men) who were living in Lancashire collected these data over seven days. An exploratory spatio-temporal analysis was conducted on the 820 activities they undertook. We discovered that our participants spend large amounts of time indoors. We also found that social interaction increases the duration of the activity and, conversely, decreases levels of physical movement. When zooming in to gender differences, men's activities took significantly longer than women's activities and were characterised by higher level of social interaction. Based on these results, we argue that there is a trade-off between social interaction and physical movement in everyday activities. We suggest establishing a balance between socialising and moving in everyday activities in later life, specifically because maintaining high levels of movement and social interaction at the same time seems unachievable. In conclusion, it is important to design indoor environments that facilitate choice between being active and resting, and between being social and being on one's own rather than assume they are mutually-exclusive and/or universally "good" or "bad" per se.
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Gilbert AS, Salvo D, Tabak RG, Haire-Joshu D. Does the neighborhood built environment moderate the effectiveness of a weight-loss intervention for mothers with overweight or obesity? Findings from the Healthy Eating and Active Living Taught at Home (HEALTH) study. Int J Behav Nutr Phys Act 2022; 19:130. [PMID: 36182908 PMCID: PMC9526987 DOI: 10.1186/s12966-022-01368-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women of childbearing age are vulnerable to weight gain and experience a high prevalence of obesity due to pregnancy and stressors of parenthood. Lifestyle interventions such as the Healthy Eating and Active Living Taught at Home (HEALTH) study have been effective for weight loss; however, little is known about how the built environment (parks, transit, grocery stores, fast food, walkability etc.), where participants live might modify intervention effectiveness. This study examined whether characteristics of the neighborhood built environment modified effectiveness of the HEALTH study on weight loss. METHODS: Secondary data analysis was conducted using data from HEALTH. Using GIS, buffers were built around participant addresses to capture distance to and availability of food (grocery store, convenience store, fast food) and urban design and transit (parks, street connectivity, transit) built environment characteristics. Built environment characteristics were dichotomized into low and high density and distance. Likelihood ratio tests for interaction were conducted to determine if built environment characteristics modified intervention effectiveness on Body mass index (BMI) and waist circumference (WC). Mixed effects linear regression models were then run to estimate the effect of the HEALTH intervention on weight outcomes at 24-months across both strata of built environment characteristics. RESULTS: The analytic sample (n = 151) had baseline mean BMI 34.9 (SD = 5.8) and mean WC 46.0 cm (SD4.9). All urban design and transit and all food environment characteristics modified HEALTH effectiveness on one or both weight outcomes. The built environment modified the HEALTH intervention such that it was mostly effective for mothers residing in neighborhoods with low transit access, low street connectivity, high park access, and low access to grocery stores, convenience stores, and fast food. CONCLUSIONS Result show the HEALTH was most effective for women residing neighborhoods with built environment characteristics suggestive of suburban neighborhood typology. To maximize impact for mothers residing in all types of neighborhoods, future research should explore scaling up HEALTH in suburban settings, while adapting HEALTH to maximize effectiveness in compact neighborhoods most likely, urban core neighborhoods.
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Affiliation(s)
- Amanda S Gilbert
- Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Deborah Salvo
- Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, St. Louis, MO, USA.
- Center for Diabetes Translation Research, Washington University in St. Louis, St. Louis, MO, USA.
- Department of Kinesiology and Health Education, College of Education, The University of Texas at Austin, Bellmont Hall (BEL) at 2109 San Jacinto Blvd., Austin, TX, 78712, USA.
| | - Rachel G Tabak
- Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, St. Louis, MO, USA
- Center for Diabetes Translation Research, Washington University in St. Louis, St. Louis, MO, USA
| | - Debra Haire-Joshu
- Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, St. Louis, MO, USA
- Center for Diabetes Translation Research, Washington University in St. Louis, St. Louis, MO, USA
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McCormack GR, Patterson M, Frehlich L, Lorenzetti DL. The association between the built environment and intervention-facilitated physical activity: a narrative systematic review. Int J Behav Nutr Phys Act 2022; 19:86. [PMID: 35836196 PMCID: PMC9284898 DOI: 10.1186/s12966-022-01326-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/23/2022] [Indexed: 11/22/2022] Open
Abstract
Background A diverse range of interventions increase physical activity (PA) but few studies have explored the contextual factors that may be associated with intervention effectiveness. The built environment (BE) may enhance or reduce the effectiveness of PA interventions, especially interventions that encourage PA in neighbourhood settings. Several studies have investigated the effects of the neighbourhood BE on intervention-facilitated PA, however, a comprehensive review of evidence has yet to be conducted. In our systematic review, we synthesize evidence from quantitative studies that have examined the relationships between objectively-measured neighbourhood BE and intervention-facilitated PA in adults. Method In October 2021, we searched 7 databases (Medline, CINAHL, Embase, Web of Science, SPORTDiscus, Environment Complete, and Cochrane Central Register of Controlled Trials) for English-language studies reporting on randomized and non-randomized experiments of physical activity interventions involving adults (≥18 years) and that estimated the association between objectively-measured BE and intervention-facilitated physical activity. Results Twenty articles, published between 2009 and 2021, were eligible for inclusion in the review. Among the 20 articles in this review, 13 included multi-arm experiments and 7 included single-arm experiments. Three studies examined PA interventions delivered at the population level and 17 examined interventions delivered at the individual level. PA intervention characteristics were heterogeneous and one-half of the interventions were implemented for at least 12-months (n = 10). Most studies were undertaken in North America (n = 11) and most studies (n = 14) included samples from populations identified as at risk of poor health (i.e., metabolic disorders, coronary heart disease, overweight, cancer, high blood pressure, and inactivity). Fourteen studies found evidence of a neighbourhood BE variable being negatively or positively associated with intervention-facilitated PA. Conclusion Approximately 70% of all studies reviewed found evidence for an association between a BE variable and intervention-facilitated PA. The BE’s potential to enhance or constrain the effectiveness of PA interventions should be considered in their design and implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-022-01326-9.
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Affiliation(s)
- Gavin R McCormack
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive, N.W., Calgary, Alberta, T2N 4Z6, Canada. .,Faculty of Kinesiology, University of Calgary, Calgary, Canada. .,Faculty of Environmental Design, University of Calgary, Calgary, Canada. .,Faculty of Sport Sciences, Waseda University, Shinjuku City, Japan.
| | - Michelle Patterson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive, N.W., Calgary, Alberta, T2N 4Z6, Canada
| | - Levi Frehlich
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive, N.W., Calgary, Alberta, T2N 4Z6, Canada
| | - Diane L Lorenzetti
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive, N.W., Calgary, Alberta, T2N 4Z6, Canada.,Health Sciences Library, University of Calgary, Calgary, Canada
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Giles LV, Koehle MS, Saelens BE, Sbihi H, Carlsten C. When physical activity meets the physical environment: precision health insights from the intersection. Environ Health Prev Med 2021; 26:68. [PMID: 34193051 PMCID: PMC8247190 DOI: 10.1186/s12199-021-00990-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/20/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The physical environment can facilitate or hinder physical activity. A challenge in promoting physical activity is ensuring that the physical environment is supportive and that these supports are appropriately tailored to the individual or group in question. Ideally, aspects of the environment that impact physical activity would be enhanced, but environmental changes take time, and identifying ways to provide more precision to physical activity recommendations might be helpful for specific individuals or groups. Therefore, moving beyond a "one size fits all" to a precision-based approach is critical. MAIN BODY To this end, we considered 4 critical aspects of the physical environment that influence physical activity (walkability, green space, traffic-related air pollution, and heat) and how these aspects could enhance our ability to precisely guide physical activity. Strategies to increase physical activity could include optimizing design of the built environment or mitigating of some of the environmental impediments to activity through personalized or population-wide interventions. CONCLUSIONS Although at present non-personalized approaches may be more widespread than those tailored to one person's physical environment, targeting intrinsic personal elements (e.g., medical conditions, sex, age, socioeconomic status) has interesting potential to enhance the likelihood and ability of individuals to participate in physical activity.
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Affiliation(s)
- Luisa V Giles
- School of Kinesiology, University of the Fraser Valley, 45190 Caen Ave, Chilliwack, British Columbia, V2R 0N3, Canada.
| | - Michael S Koehle
- School of Kinesiology, University of British Columbia, 210-6081 University Boulevard, Vancouver, British Columbia, V6T 1Z1, Canada
- Division of Sport & Exercise Medicine, Faculty of Medicine, University of British Columbia, 2553 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Brian E Saelens
- Department of Pediatrics, University of Washington, and Seattle Children's Research Institute, 2001 Eighth Ave, Suite 400, Seattle, Washington, 98121, USA
| | - Hind Sbihi
- British Columbia Centre for Disease Control, 655 West 12th Ave, Vancouver, British Columbia, V5Z 4R4, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Chris Carlsten
- Department of Medicine, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Vancouver, British Columbia, V5Z 1M9, Canada
- Legacy for Airway Health, 2775 Laurel Street, 7th Floor, Vancouver, British Columbia, V5Z 1M9, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada
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Colom A, Mavoa S, Ruiz M, Wärnberg J, Muncunill J, Konieczna J, Vich G, Barón-López FJ, Fitó M, Salas-Salvadó J, Romaguera D. Neighbourhood walkability and physical activity: moderating role of a physical activity intervention in overweight and obese older adults with metabolic syndrome. Age Ageing 2021; 50:963-968. [PMID: 33219673 PMCID: PMC8248320 DOI: 10.1093/ageing/afaa246] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND While urban built environments might promote active ageing, an infrequently studied question is how the neighbourhood walkability modulates physical activity changes during a physical activity intervention programme in older adults. We assessed the influence of objectively assessed neighbourhood walkability on the change in physical activity during the intervention programme used in the ongoing PREvención con DIeta MEDiterránea (PREDIMED)-Plus trial. METHOD The present study involved 228 PREDIMED-Plus senior participants aged between 55 and 75, recruited in Palma de Mallorca (Spain). Overweight/obese older adults with metabolic syndrome were randomised to an intensive weight-loss lifestyle intervention or a control group. A walkability index (residential density, land use mix, intersections density) was calculated using geographic information systems (1 km sausage-network buffer). Physical activity was assessed using accelerometer and a validated questionnaire, at baseline and two follow-up visits (6-months and 1-year later). Generalised additive mixed models were fitted to estimate the association between the neighbourhood walkability index and changes in physical activity during follow-up. RESULTS Higher neighbourhood walkability (1 z-score increment) was associated with moderate-to-vigorous accelerometer assessed physical activity duration, (β = 3.44; 95% CI = 0.52; 6.36 min/day). When analyses were stratified by intervention arm, the association was only observed in the intervention group (β = 6.357; 95% CI = 2.07;10.64 min/day) (P for interaction = 0.055). CONCLUSIONS The results indicate that the walkability of the neighbourhood could support a physical activity intervention, helping to maintain or increase older adults' physical activity.
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Affiliation(s)
- Antoni Colom
- Research Group on Nutritional Epidemiology &
Cardiovascular Physiopathology, Health Research Institute
of the Balearic Islands (IdISBa). University Hospital Son
Espases, 07120 Palma, Spain
- Consorcio CIBER, M.P. Fisiopatología de
la Obesidad y Nutrición (CIBERObn), Instituto de Salud
Carlos III (ISCIII), Madrid, Spain
| | - Suzanne Mavoa
- Mary MacKillop Institute for Health Research,
Australian Catholic University, Melbourne,
Australia
- Melbourne School of Population and Global
Health, University of Melbourne,
Melbourne, Australia
| | - Maurici Ruiz
- Research Group on Nutritional Epidemiology &
Cardiovascular Physiopathology, Health Research Institute
of the Balearic Islands (IdISBa). University Hospital Son
Espases, 07120 Palma, Spain
- Servicio de SIG y Teledetección,
Vicerectorat d’Innovació i Transferència,
Universitat de les Illes Balears, Palma,
Spain
| | - Julia Wärnberg
- Consorcio CIBER, M.P. Fisiopatología de
la Obesidad y Nutrición (CIBERObn), Instituto de Salud
Carlos III (ISCIII), Madrid, Spain
- Departamento de Enfermería, Facultad de
Ciencias de la Salud, Universidad de Málaga –
Instituto de Investigación en Biomedicina (IBIMA),
Málaga, Spain
| | - Josep Muncunill
- Genomics and Bioinformatics Platform, Balearic
Islands Health Research Institute (IdISBa), University Hospital
Son Espases, Palma, Spain
| | - Jadwiga Konieczna
- Research Group on Nutritional Epidemiology &
Cardiovascular Physiopathology, Health Research Institute
of the Balearic Islands (IdISBa). University Hospital Son
Espases, 07120 Palma, Spain
- Consorcio CIBER, M.P. Fisiopatología de
la Obesidad y Nutrición (CIBERObn), Instituto de Salud
Carlos III (ISCIII), Madrid, Spain
| | - Guillem Vich
- Geography Department, Autonomous
University of Barcelona, Bellaterra, Spain
| | - Francisco Javier Barón-López
- Consorcio CIBER, M.P. Fisiopatología de
la Obesidad y Nutrición (CIBERObn), Instituto de Salud
Carlos III (ISCIII), Madrid, Spain
- Departamento de Salud Pública, Facultad
de Medicina, Universidad de Málaga – Instituto de
Investigación en Biomedicina (IBIMA),
Málaga, Spain
| | - Montserrat Fitó
- Consorcio CIBER, M.P. Fisiopatología de
la Obesidad y Nutrición (CIBERObn), Instituto de Salud
Carlos III (ISCIII), Madrid, Spain
- Unit of Cardiovascular Risk and Nutrition,
Institut Hospital del Mar de Investigaciones Médicas
Municipal d’Investigació Mèdica
(IMIM), Barcelona, Spain
| | - Jordi Salas-Salvadó
- Consorcio CIBER, M.P. Fisiopatología de
la Obesidad y Nutrición (CIBERObn), Instituto de Salud
Carlos III (ISCIII), Madrid, Spain
- Universitat Rovira i Virgili, Departament de
Bioquímica i Biotecnologia, Unitat de Nutrició
Humana. Hospital Universitari San Joan de Reus, Reus,
Spain
- Institut d'Investigació Pere Virgili
(IISPV), Human Nutrition Unit: Prevention and Epigenetics,
Reus, Spain
| | - Dora Romaguera
- Research Group on Nutritional Epidemiology &
Cardiovascular Physiopathology, Health Research Institute
of the Balearic Islands (IdISBa). University Hospital Son
Espases, 07120 Palma, Spain
- Consorcio CIBER, M.P. Fisiopatología de
la Obesidad y Nutrición (CIBERObn), Instituto de Salud
Carlos III (ISCIII), Madrid, Spain
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11
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Cao Y, Heng CK, Fung JC. Using Walk-Along Interviews to Identify Environmental Factors Influencing Older Adults' Out-of-Home Behaviors in a High-Rise, High-Density Neighborhood. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214251. [PMID: 31683860 PMCID: PMC6862061 DOI: 10.3390/ijerph16214251] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/12/2019] [Accepted: 10/30/2019] [Indexed: 01/10/2023]
Abstract
Older adults’ out-of-home behaviors (OOHBs) are critical for maintaining health and quality of life. Taking Singapore’s Yuhua East as a case, this study applied a qualitative approach to explore what neighborhood environmental factors influence older adults’ OOHBs. Twelve older adults were recruited for walk-along interviews through the use of purposeful convenience sampling. A content analysis was conducted using NVivo 11 via an inductive approach. Research results revealed 12 categories of environmental factors that affected older adults’ OOHBs: access to facilities (shops and services, public transit, and connectivity), pedestrian infrastructure (sidewalk quality, sheltered walkways, universal design, crossings, benches, and public toilets), aesthetics (natural elements, buildings, noise, and cleanliness), traffic safety (behavior of other road users and road width), safety from crime, wayfinding, familiarity (long-term residency and routine activities), weather, social contact, high-rise, high-density (lifts, population density, flat size, and privacy), affordability (shops and services, as well as transportation), and maintenance and upgrading. This analysis concluded that access to facilities and pedestrian infrastructure are important for older adults’ OOHBs. Considering Singapore’s weather, sheltered walkways, the proximity of facilities and connectivity should be given serious emphasis. In addition to physical factors, social contacts and the affordability of shops and services are also important.
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Affiliation(s)
- Yuxin Cao
- Center for Ageing Research in the Environment, School of Design and Environment, National University of Singapore, Singapore 117566, Singapore.
| | - Chye Kiang Heng
- Department of Architecture, National University of Singapore, Singapore 117566, Singapore.
| | - John Chye Fung
- Center for Ageing Research in the Environment, School of Design and Environment, National University of Singapore, Singapore 117566, Singapore.
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12
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Zenk SN, Tarlov E, Wing C, Slater S, Jones KK, Fitzgibbon M, Powell LM. Does the built environment influence the effectiveness of behavioral weight management interventions? Prev Med 2019; 126:105776. [PMID: 31330154 PMCID: PMC6878977 DOI: 10.1016/j.ypmed.2019.105776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/01/2019] [Accepted: 07/14/2019] [Indexed: 11/28/2022]
Abstract
Outcomes of behavioral lifestyle interventions for promoting weight loss vary widely across participants. The effectiveness of a weight management intervention may depend on a person's environmental context. This study compared short- and longer-term effects of a structured nationwide weight management program for people living in neighborhoods with different levels of walkability and different access to recreational places (parks, fitness facilities). Drawing on the health production model, we tested competing hypotheses for whether treatment effects of the program complement environmental supports or substitute for environmental constraints. We studied the US Department of Veterans Affairs (VA) MOVE! weight management program using VA electronic heath record data (2009-2014) and a difference-in-differences design with an inverse propensity score matched comparison group. A total of 114,256 program participants and 498,494 non-participants comprised the sample. Built environment features were measured within one-mile of each person's home. We estimated program effects on body mass index (BMI) for subgroups with different built environments at 6-, 12-, 18-, and 24-month follow-up using linear regressions with person and year fixed effects. At 6 months, the program reduced BMI by 0.4-0.6 kg/m2 among men and 0.3-0.5 kg/m2 among women. The effect diminished at 12, 18, and 24 months. The program effect did not vary significantly across subgroups with different walkability, park access, or fitness facility access. The MOVE! program was not sensitive to environmental context. Results did not lend support to either hypothesis that the MOVE! program complements or substitutes for a person's built environment to affect weight management outcomes.
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Affiliation(s)
- Shannon N Zenk
- University of Illinois at Chicago College of Nursing, 845 S. Damen Ave., Chicago, IL 60612, USA.
| | - Elizabeth Tarlov
- University of Illinois at Chicago College of Nursing, 845 S. Damen Ave., Chicago, IL 60612, USA; Edward Hines Jr. Veterans Affairs Hospital, Hines, IL 60141, USA.
| | - Coady Wing
- Indiana University School of Public and Environmental Affairs, Bloomington, IN 47405, USA.
| | - Sandy Slater
- University of Illinois at Chicago College of Nursing, 845 S. Damen Ave., Chicago, IL 60612, USA; University of Illinois at Chicago School of Public Health, Chicago, IL 60612, USA.
| | - Kelly K Jones
- University of Illinois at Chicago College of Nursing, 845 S. Damen Ave., Chicago, IL 60612, USA.
| | - Marian Fitzgibbon
- University of Illinois at Chicago Institute for Health Research and Policy, Chicago, IL 60612, USA; University of Illinois at Chicago Department of Pediatrics, Chicago, IL 60612, USA.
| | - Lisa M Powell
- University of Illinois at Chicago Institute for Health Research and Policy, Chicago, IL 60612, USA; University of Illinois at Chicago School of Public Health, Chicago, IL 60612, USA.
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13
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Klann A, Vu L, Ewing M, Fenton M, Pojednic R. Translating Urban Walkability Initiatives for Older Adults in Rural and Under-Resourced Communities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173041. [PMID: 31443359 PMCID: PMC6747272 DOI: 10.3390/ijerph16173041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 07/29/2019] [Accepted: 08/14/2019] [Indexed: 12/26/2022]
Abstract
The built environment can promote physical activity in older adults by increasing neighborhood walkability. While efforts to increase walkability are common in urban communities, there is limited data related to effective implementation in rural communities. This is problematic, as older adults make up a significant portion of rural inhabitants and exhibit lower levels of physical activity. Translating lessons from urban strategies may be necessary to address this disparity. This review examines best practices from urban initiatives that can be implemented in rural, resource-limited communities. The review of the literature revealed that simple, built environment approaches to increase walkability include microscale and pop-up infrastructure, municipal parks, and community gardens, which can also increase physical activity in neighborhoods for urban older adults. These simple and cost-effective strategies suggest great potential for rural communities.
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Affiliation(s)
- Alexandra Klann
- Department of Nutrition, Simmons University, Boston, MA 02115, USA
| | - Linh Vu
- Department of Nutrition, Simmons University, Boston, MA 02115, USA
| | - Mollie Ewing
- Children and Family Services Corporation, Vincennes, IN 47951, USA
| | - Mark Fenton
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
| | - Rachele Pojednic
- Department of Nutrition, Simmons University, Boston, MA 02115, USA.
- Harvard Medical School, Institute of Lifestyle Medicine, Boston, MA 02115, USA.
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14
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Resnick B, Galik E, Boltz M, Vigne E, Holmes S, Fix S, Zhu S, Lewis R. Testing of the Function Focused Environment Assessment and the Function Focused Policy Assessment in Assisted Living. JOURNAL OF HOUSING FOR THE ELDERLY 2019; 33:153-172. [PMID: 32038064 PMCID: PMC7006224 DOI: 10.1080/02763893.2018.1534180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study tested two new instruments, the Function Focused Environment Assessment (FF-EA) and the Function Focused Policy Assessment (FF-PA). The measures were developed for clinical evaluation of AL settings to help optimize function and physical activity among residents. A total of 106 AL settings and 242 residents were included. There was evidence of item reliability (0.92) and interrater reliability (kappa=0.40, p=.015; percent agreement 85%) of FF-EA and item reliability (0.89) and interrater reliability (kappa=0.48, p=.001, percent agreement 82%) of the FF-PA, and support for validity of both measures based on INFIT and OUTFIT statistics and hypothesis testing.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, 655 West Lombard St, Baltimore MD 21218
| | - Elizabeth Galik
- University of Maryland School of Nursing, 655 West Lombard St, Baltimore MD 21218
| | - Marie Boltz
- Pennsylvania State University, College of Nursing, 201 Nursing Sciences Building, University Park, PA 16802
| | - Erin Vigne
- University of Maryland School of Nursing, 655 West Lombard St, Baltimore MD 21218
| | - Sarah Holmes
- University of Maryland School of Nursing, 655 West Lombard St, Baltimore MD 21218
| | - Steven Fix
- University of Maryland School of Nursing, 655 West Lombard St, Baltimore MD 21218
| | - Shijun Zhu
- University of Maryland School of Nursing, 655 West Lombard St, Baltimore MD 21218
| | - Regina Lewis
- The Pennsylvania State University, College of Nursing, 303 B Nursing Sciences Building, University Park, PA 16802
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15
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Han M, Ye X, Preciado P, Williams S, Campos I, Bonner M, Young C, Marsh D, Larkin JW, Usvyat LA, Maddux FW, Pecoits-Filho R, Kotanko P. Relationships between Neighborhood Walkability and Objectively Measured Physical Activity Levels in Hemodialysis Patients. Blood Purif 2018; 45:236-244. [PMID: 29478044 DOI: 10.1159/000485161] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Neighborhood walkability is associated with indicators of health in the general population. We explored the association between neighborhood walkability and daily steps in hemodialysis (HD) patients. METHODS We measured daily steps over 5 weeks using Fitbit Flex (Fitbit, San Francisco, CA, USA) and retrieved Walk Score® (WS) data by patient's home ZIP code (www.walkscore.com; 0 = poorest walkability; 100 = greatest walkability). RESULTS HD patients took a mean of 6,393 ± 3,550 steps/day (n = 46). Median WS of the neighborhood where they resided was 28. Patients in an above-median WS (n = 27) neighborhood took significantly more daily steps compared to those (n = 19) in a below-median WS neighborhood (7,514 ± 3,900 vs. 4,800 ± 2,228 steps/day; p < 0.001, t test). Daily steps and WS were directly correlated (R = 0.425; p = 0.0032, parametric test; R = 0.359, p = 0.0143, non-parametric test). CONCLUSION This is the first study conducted among HD patients to indicate a direct relationship between neighborhood walkability and the actual steps taken. These results should be considered when designing initiatives to increase and improvise exercise routines in HD populations.
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Affiliation(s)
- Maggie Han
- Renal Research Institute, New York, New York, USA
| | - Xiaoling Ye
- Renal Research Institute, New York, New York, USA
| | | | | | | | | | | | | | - John W Larkin
- Pontificia Universidade Catolica do Parana, Curitiba, Brazil.,Fresenius Medical Care North America, Waltham, Massachusetts, USA
| | - Len A Usvyat
- Fresenius Medical Care North America, Waltham, Massachusetts, USA
| | | | | | - Peter Kotanko
- Renal Research Institute, New York, New York, USA.,Icahn School of Medicine, New York, New York, USA
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