Sports facilities in Madrid explain the relationship between neighbourhood economic context and physical inactivity in older people, but not in younger adults: a case study

The interplay between social environment and opportunities for physical activity within the built environment: a scoping review

BACKGROUND

The association between social and built environments plays a crucial role in influencing physical activity levels. However, a thorough understanding of their combined impact remains unclear. This scoping review seeks to clarify the interplay between social environments and opportunities for physical activity within different built environments, with a particular focus on the implications of socioeconomic status and urban planning on physical activity participation.

METHODS

We conducted a systematic literature search across several databases to identify studies exploring the associations between social factors, built environment characteristics, and physical activity levels. The inclusion criteria were studies published in English between 2000 and 2022, encompassing urban, suburban, and rural contexts. Thematic analysis was employed to categorise studies based on the specific aspects of the built environment they investigated (walking infrastructure, cycling infrastructure, parks and open spaces, and sports facilities) and the social determinants they examined.

RESULTS

A total of 72 studies were included in the review, illustrating a multifaceted relationship between access to physical activity opportunities and social determinants such as socioeconomic status, community engagement, and urban design. The findings highlight the significant role of socioeconomic factors and the quality of PA infrastructure in promoting or hindering PA across communities. Effective urban planning was identified as crucial in providing expanded physical activity opportunities, notably through more pedestrian-friendly environments, comprehensive cycling infrastructure, and accessible green spaces and sports facilities.

CONCLUSIONS

This review emphasises the significant impact of socioeconomic status and urban planning on access to physical activity opportunities. This underscores the necessity for urban planning policies to adopt an inclusive approach, considering the varied needs of different population groups to ensure equitable access to physical activity resources. Such strategies are crucial for public health initiatives aimed at enhancing physical activity levels across diverse community sectors, offering a potential avenue to alleviate health disparities associated with inactivity.

Indicators of community physical activity resources and opportunities and variation by community sociodemographic characteristics: A scoping review

Objective

This scoping review synthesizes studies examining community-level variability in physical activity resource (assets) and opportunity (organized group physical activity services) availability by community sociodemographic characteristics to describe methodologies for measuring resources/opportunities, indicators characterizing availability, and associations between community-level sociodemographic characteristics and availability.

Methods

A systematic search was conducted in MEDLINE, CINAHL, PsycINFO, and Scopus for literature through 2022. Eligible studies quantitatively examined measures of physical activity resource/opportunity availability by community-level racial, ethnic, and/or socioeconomic characteristics within geospatially defined communities. Extracted data included: community geospatial definitions, sociodemographic characteristics assessed, methodologies for measuring and indicators of community physical activity resource/opportunity availability, and study findings.

Results

Among the 46 included studies, community geospatial units were defined by 28 different community boundaries (e.g., town), and 13% of studies were conducted in rural areas. Nearly all (98%) studies measured community-level socioeconomic status, and 45% of studies measured race/ethnicity. A total of 41 indicators of physical activity resource/opportunity availability were identified. Most studies (91%) assessed built environment resources (e.g., parks), while 8.7% of studies assessed opportunities (e.g., programs). Of 141 associations/differences between community sociodemographic characteristics and resource/opportunity availability, 29.8% indicated greater availability in communities of higher socioeconomic status or lower prevalence of minority populations. The remaining findings were in the opposite direction (9.2%), non-significant (36.9%), or mixed (24.1%).

Conclusions

Variability in physical activity resources/opportunities by community sociodemographic characteristics was not consistently evident. However, the indicators synthesized may be useful for informing population health improvement efforts by illuminating the physical and social conditions impacting population physical activity outcomes.

Exercise facility availability and incidence of type 2 diabetes and complications in Spain: A population-based retrospective cohort 2015-2018

BACKGROUND

To study the association between exercise facility availability and type 2 diabetes incidence and its complications, and to explore effect modification by socioeconomic status (SES) and sex in the Madrid adult population.

METHODS

A multilevel longitudinal design, based on a population-based retrospective cohort including 1,214,281 residents of Madrid (Spain) aged 40-75 years from 2015 to 2018. Outcomes were type 2 diabetes incidence and macrovascular (cardiac ischemia and/or stroke) and microvascular (chronic kidney disease, retinopathy, and/or peripheral vascular disease) complications in those with diabetes at baseline. Exercise facility availability was defined as the count of exercise facilities in a 1000 m street network buffer around each participant's residence. Poisson regression models with robust standard errors were used to estimate the risk ratios (RR). Interactions were explored with SES tertiles and by sex.

RESULTS

Residents living in areas with lower exercise facility availability showed higher risk of type 2 diabetes (RR_tertile3vs1 = 1.25, CI95% 1.21-1.30) as well as macrovascular (RR_Tertile3vs1 = 1.09 CI95% 1.00-1.19), and microvascular (RR_Tertile3vs1 = 1.10 CI95% 1.01-1.19) complications. Associations were strongest in low SES areas for type 2 diabetes (RR_{tertile3vs1-LOW-SES} = 1.22, CI95% 1.12-1.32; RR_{tertile3vs1-HIGH-SES} = 0.91, CI95% 0.85-0.98) and microvascular complications (RR_{tertile3vs1-LOW-SES} = 1.12, CI95% 0,94-1,33; RR_{tertile3vs1-HIGH-SES} = 0.88, CI95% 0.73-1.05).

CONCLUSIONS

Living in areas with lower availability of exercise facilities was associated with a greater risk of type 2 diabetes and its complications. Increasing exercise opportunities, particularly in low SES areas, could help reduce the social gradient of diabetes and its complications.

Exercise facilities and the prevalence of obesity and type 2 diabetes in the city of Madrid

AIMS/HYPOTHESIS

We aimed to study the association between the availability of exercise facilities and the likelihood of obesity and type 2 diabetes in the adult population of Madrid, Spain.

METHODS

We analysed the electronic medical records of all 1,270,512 residents of Madrid aged 40-75 years in 2017. Exercise facility availability was defined as the count of exercise facilities in a 1000 m street network buffer around each residential building entrance. Poisson regression with standard errors clustered at census tract level was used to assess prevalence ratios of exercise facility availability tertiles and obesity and type 2 diabetes. We also examined stratified results by tertiles of area-level socioeconomic status (SES) and sex.

RESULTS

People living in areas with lower availability of exercise facilities had a higher prevalence of obesity (prevalence ratio [PR] 1.22 [95% CI 1.20, 1.25]) and diabetes (PR 1.38 [95% CI 1.34, 1.43]). We observed effect modification by area-level SES (p<0.001), with stronger associations for residents living in low-SES areas and no association for residents living in high-SES areas. Associations with type 2 diabetes were stronger among women compared with men, while associations with obesity were similar by sex.

CONCLUSIONS/INTERPRETATION

People living in areas with low availability of exercise facilities had a higher prevalence of obesity and type 2 diabetes, and this association was strongest in low-SES areas and for women. Understanding the potential role of exercise facilities in driving inequities in obesity and type 2 diabetes prevalence may inform interventions to reduce health inequities.

The Acceptability of Physical Activity to Older Adults Living in Lower Socioeconomic Status Areas: A Multi-Perspective Study

Older adults in lower socioeconomic status (SES) areas are the least active of all adult groups but are often absent from physical activity research. The present study aimed to elicit perspectives on acceptability of physical activity from older adults and physical activity providers in lower SES areas. Semi-structured interviews were conducted with 19 older adults and eight physical activity trainers/providers in lower SES areas. An inductive, multi-perspective Thematic Analysis was conducted. Eight themes were identified that covered one or both groups’ perceptions of what was important in ensuring acceptability of activity provision. Older adults perceived a lack of value that was reinforced by lack of resources and unequal provision. Acceptability was hindered by centralisation of facilities and lack of understanding of needs by facility management. Facilitating social interaction within physical activities appeared key, thereby meeting multiple needs with fewer resources. In conclusion, to increase acceptability of physical activity for older adults in low SES areas, providers should address the lack of perceived value felt by many older adults. Equitable provision of physical activities addressing multiple needs may allow older adults with limited resources to be physically active without sacrificing other needs. Facilitating creation of social bonds may foster maintenance of physical activities.

Can we improve our neighbourhoods to be more physically active? Residents' perceptions from a qualitative urban health inequalities study

The objective of our study was to identify neighbourhood factors which prevent and encourage physical activity, according to the residents' perspective. We used qualitative methods, conducting 37 semi-structured interviews and 29 focus groups. The main results were that the type of physical activity that took place in every neighbourhood was different; access to sports facilities varied due to prices and safety issues; garbage and obstacles on sidewalks were a serious limitation to physical activity; economic instability had an impact on physical activity. These results might lead the perception and insights of residents to be considered in public health interventions.

Does a physical activity supportive environment ameliorate or exacerbate socioeconomic inequities in incident coronary heart disease?

BACKGROUND

Efforts to reduce socioeconomic inequities in cardiovascular disease include interventions to change the built environment. We aimed to explore whether socioeconomic inequities in coronary heart disease (CHD) incidence are ameliorated or exacerbated in environments supportive of physical activity (PA).

METHODS

We used data from the Reasons for Geographic and Racial Differences in Stroke study, which recruited US residents aged 45 or older between 2003 and 2007. Our analyses included participants at risk for incident CHD (n=20 808), followed until 31 December 2014. We categorised household income and treated it as ordinal: (1) US$75 000+, (2) US$35 000-US$74 000, (3) US$20 000-US$34 000 and (4)

RESULTS

We found a 25% (95% CI 1.17% to 1.34%) increased hazard of CHD per 1-category decrease in household income category. Adjusting for PA-supportive environments slightly reduced this association (HR=1.24). The income-CHD association was strongest in areas without walking destinations (HR=1.57), an interaction which reached statistical significance in analyses among men. In contrast, the income-CHD association showed a trend towards being strongest in areas with the highest percentage of green land cover.

CONCLUSIONS

Indicators of a PA supportive environment show divergent trends to modify socioeconomic inequities in CHD . Built environment interventions should measure the effect on socioeconomic inequities.

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Key Words

• cardiovascular disease
• neighborhood/place
• socio-economic

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MESH Headings Collapse

Grants

• DP5 OD026429 NIH HHS
• R01 AG049970 NIA NIH HHS
• U01 NS041588 NINDS NIH HHS

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Affiliation(s)

Pedro Gullon Public Health and Epidemiology Research Group, Universidad de Alcala de Henares Facultad de Medicina y Ciencias de la Salud, Alcala de Henares, Spain Urban Health Collaborative, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
Usama Bilal Urban Health Collaborative, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA Epidemiology and Statistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
Jana A Hirsch Urban Health Collaborative, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA Epidemiology and Statistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
Andrew G Rundle Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
Suzanne Judd Department of Biostatistics, University of Alabama at Birmingham College of Arts and Sciences, Birmingham, Alabama, USA
Monika M Safford Department of Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, New York, USA
Gina S Lovasi Urban Health Collaborative, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA Epidemiology and Statistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA

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Difficulties Limiting Access to Sports and Recreational Facilities in the City in the Perceptions of Service Users. Sports and Recreational Infrastructure Management Policy-Poznan Case Study

The range of sports and recreation facilities' offer should be very wide in order for all social groups of the examined environment to have access to sports and recreation facilities. Therefore, Poznan City Hall should take into account all difficulties that limit the access to these facilities when preparing management policy of sports and recreation infrastructure and its functioning. That is why the main goal of this study is to recognize difficulties limiting the access to sports and recreation facilities in this city. The research carried out at indoor tennis courts (16 facilities), indoor swimming polls (12 facilities) and fitness clubs (11 facilities) in Poznan covered 1159 service recipients (using the services of a given sports and recreation facility). The author-constructed questionnaire addressed to the service recipients (residents of the city of Poznan who use the services offered at the examined sports and recreation facilities). Furthermore, the service recipients were divided into a group of people doing sports competitively and a group of recipients who have never practiced sports as professional athletes. The validated questionnaire sent to the examined service recipients included suggestions of difficulties that may limit the access to sports and recreation facilities in the city of Poznan. Further analysis of the importance of difficulties that limit the access to sports and recreation facilities may allow indicating the reason why recreational activity of residents is limited. A lower level of satisfaction and thus a lower rating of the respondents was obtained by a set of features constituting, according to the respondents, difficulties limiting the access to the use of sports and recreation facilities (high prices and too great of a distance of the sports and recreation facility from the place of residence).

Impact of social disadvantages in the presence of diabetes at old age

Background

Social disadvantages that start during childhood and continue into the later stages in life may be linked to the presence of diabetes during adulthood. Objective. To analyze whether the presence of social disadvantages in childhood and in the present affects the presence of diabetes in older adults.

Methods

The present study was based on longitudinal data from the third and fourth Mexican Health and Aging Study (MHAS) waves (2012 and 2015). Data on diabetes diagnosis, past (e.g. “no shoes during childhood”) and present (e.g. self-perception of economic status) social disparities, and other covariables were analyzed.

Results

From 8,848 older adults, 21.5% (n = 1903) were classified as prevalent cases (PG), 5.2% (n = 459) as incident cases (IG) and 77.4% (n = 6,486) were free of disease (NDG). The predictor variable “no shoes during childhood” was statistically significant in the model incident versus no diabetes group. Hypertension and body mass index (BMI) were the most relevant covariates as they were statistically significant in the three groups (PG, IG and NDG).

Conclusions

Not having shoes during childhood, an indicator of social disadvantages, is associated with the incidence and prevalence of diabetes in older adults. This suggests that social disadvantages can be a determinant for the presence of chronic diseases in adulthood.

Access to and availability of exercise facilities in Madrid: an equity perspective

BACKGROUND

Identifying socioeconomic determinants that are associated with access to and availability of exercise facilities is fundamental to supporting physical activity engagement in urban populations, which in turn, may reduce health inequities. This study analysed the relationship between area-level socioeconomic status (SES) and access to, and availability of, exercise facilities in Madrid, Spain.

METHODS

Area-level SES was measured using a composite index based on seven sociodemographic indicators. Exercise facilities were geocoded using Google Maps and classified into four types: public, private, low-cost and sessional. Accessibility was operationalized as the street network distance to the nearest exercise facility from each of the 125,427 residential building entrances (i.e. portals) in Madrid. Availability was defined as the count of exercise facilities in a 1000 m street network buffer around each portal. We used a multilevel linear regression and a zero inflated Poisson regression analyses to assess the association between area-level SES and exercise facility accessibility and availability.

RESULTS

Lower SES areas had a lower average distance to the closest facility, especially for public and low-cost facilities. Higher SES areas had higher availability of exercise facilities, especially for private and seasonal facilities.

CONCLUSION

Public and low-cost exercise facilities were more proximate in low SES areas, but the overall number of facilities was lower in these areas compared with higher SES areas. Increasing the number of exercise facilities in lower SES areas may be an intervention to improve health equity.

Parents' Perceived Barriers to Accessing Sports and Recreation Facilities in Ontario, Canada: Exploring the Relationships between Income, Neighbourhood Deprivation, and Community

Sports and recreation facilities provide places where children can be physically active. Previous research has shown that availability is often worse in lower-socioeconomic status (SES) areas, yet others have found inverse relationships, no relationships, or mixed findings. Since children's health behaviours are influenced by their parents, it is important to understand parents' perceived barriers to accessing sports and recreation facilities. Data from computer assisted telephone interviews with parents living in Ontario, Canada were merged via postal codes with neighbourhood deprivation data. Multivariable logistic regression modeling was used to estimate the likelihood that parents reported barriers to accessing local sports and recreation facilities. Parents with lower household incomes were more likely to report barriers to access. For each unit increase in deprivation score (i.e., more deprived), the likelihood of reporting a barrier increased 16% (95% CI: 1.04, 1.28). For parents, the relationships between household income, neighbourhood-level deprivation, and barriers are complex. Understanding these relationships is important for research, policy and planning, as parental barriers to opportunities for physical activity have implications for child health behaviours, and ultimately childhood overweight and obesity.

Intersection of neighborhood dynamics and socioeconomic status in small-area walkability: the Heart Healthy Hoods project

Background

Previous studies found a complex relationship between area-level socioeconomic status (SES) and walkability. These studies did not include neighborhood dynamics. Our aim was to study the association between area-level SES and walkability in the city of Madrid (Spain) evaluating the potential effect modification of neighborhood dynamics.

Methods

All census sections of the city of Madrid (n = 2415) were included. Area-level SES was measured using a composite index of 7 indicators in 4 domains (education, wealth, occupation and living conditions). Two neighborhood dynamics factors were computed: gentrification, proxied by change in education levels in the previous 10 years, and neighborhood age, proxied by median year of construction of housing units in the area. Walkability was measured using a composite index of 4 indicators (Residential Density, Population Density, Retail Destinations and Street Connectivity). We modeled the association using linear mixed models with random intercepts.

Results

Area-level SES and walkability were inversely and significantly associated. Areas with lower SES showed the highest walkability. This pattern did not hold for areas with an increase in education level, where the association was flat (no decrease in walkability with higher SES). Moreover, the association was attenuated in newly built areas: the association was stronger in areas built before 1975, weaker in areas built between 1975 and 1990 and flat in areas built from 1990 on.

Conclusion

Areas with higher neighborhood socioeconomic status had lower walkability in Madrid. This disadvantage in walkability was not present in recently built or gentrified areas.

Electronic supplementary material

The online version of this article (doi:10.1186/s12942-017-0095-7) contains supplementary material, which is available to authorized users.

Socio-economic environment, area facilities and obesity and physical inactivity among children

BACKGROUND

To evaluate whether the relationship between socio-economic environment and obesity and physical inactivity in children can be explained by household socio-economic position and area facilities.

METHODS

Two indicators of the socio-economic context of neighbourhood of residence based on wealth and deprivation were estimated in a sample of 727 children and adolescents residents in Madrid (Spain). Multilevel logit models were used to calculate the relationship between each indicator and obesity and physical inactivity.

RESULTS

After adjusting for household socio-economic position, obesity prevalence was 3.79 times higher among subjects living in deprived areas than among those living in non-deprived areas (CI: 1.95-7.34), and 2.38 higher among subjects living in less wealthy areas than in those living in wealthier areas (CI: 0.85-6.65). Adjustment for the availability of retail shops in subjects' neighbourhood of residence failed to change the magnitude of the association. Neither neighbourhood socio-economic context nor availability of sports facilities was related to physical inactivity.

CONCLUSION

In the city of Madrid, socio-economic context of neighbourhood of residence shows an inverse relationship with obesity but not with physical inactivity among children. The relationship observed with obesity is not explained by the availability of area facilities.

Are GIS-modelled routes a useful proxy for the actual routes followed by commuters?

Active commuting offers the potential to increase physical activity among adults by being built into daily routines. Characteristics of the route to work may influence propensity to walk or cycle. Geographic information system (GIS) software is often used to explore this by modelling routes between home and work. However, if the validity of modelled routes depends on the mode of travel used, studies of environmental determinants of travel may be biased. We aimed to understand how well modelled routes reflect those actually taken, and what characteristics explain these differences. We compared modelled GIS shortest path routes with actual routes measured using QStarz BT-Q1000X Global Positioning System (GPS) devices in a free-living sample of adults working in Cambridge and using varying travel modes. Predictors of differences, according to length and percentage overlap, between the two route sets were assessed using multilevel regression models and concordance coefficients. The 276 trips, made by 51 participants, were on average 27% further than modelled routes, with an average geographical overlap of 39%. However, predictability of the route depended on travel mode. For route length, there was moderate-to-substantial agreement for journeys made on foot and by bicycle. Route overlap was lowest for trips made by car plus walk (22%). The magnitude of difference depended on other journey characteristics, including travelling via intermediate destinations, distance, and use of busy roads. In conclusion, GIS routes may be acceptable for distance estimation and to explore potential routes, particularly active commuting. However, GPS should be used to obtain accurate estimates of environmental contexts in which commuting behaviour actually occurs. Public health researchers should bear these considerations in mind when studying the geographical determinants and health implications of commuting behaviour, and when recommending policy changes to encourage active travel.

Participation in sport and physical activity: associations with socio-economic status and geographical remoteness

Background

Many factors influence participation in sport and Physical Activity (PA). It is well established that socio-economic status (SES) is a critical factor. There is also growing evidence that there are differences in participation patterns according to residential location. However, little is known more specifically about the relationship of PA participation and frequency of participation in particular contexts, to SES and residential location. This study investigated the relationship of participation, and frequency and context of participation, to SES and location.

Methods

Three aspects of participation were investigated from data collected in the Exercise, Recreation and Sport Survey (ERASS) 2010 of persons aged 15+ years: any participation (yes, no), regular participation (<12 times per year, ≥12 times per year) and level of organisation of participation setting (non-organised, organised non-club setting, club setting).

Results

The rates of both any and regular PA participation increased as SES increased and decreased as remoteness increased. However, participation in PA was SES- or remoteness-prohibitive for only a few types of PA. As remoteness increased and SES decreased, participation in many team sports actually increased. For both SES and remoteness, there were more significant associations with overall participation, than with regular participation or participation in more organised contexts.

Conclusions

This study demonstrates the complexity of the associations between SES and location across different contexts of participation. Nevertheless, it seems that once initial engagement in PA is established, SES and remoteness are not critical determinants of the depth of engagement.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1796-0) contains supplementary material, which is available to authorized users.