Relationship between objectively measured walkability and exercise walking among adults with diabetes

How different are objective operationalizations of walkability for older adults compared to the general population? A systematic review

Background

Walking is an essential activity for everyone and for older adults in particular, given that it is the most accessible form of physical activity and one of the healthiest transportation modes. Understanding how walkability (the potential of the environment to enable and/or encourage walking) has been objectively measured and analyzed for older adults is critical to create more inclusive, healthy, and sustainable environments and to promote healthy aging. Despite the numerous reviews on physical activity among older adults and its relationship with the built environment, the literature still lacks comparison reviews focusing specifically on objective operationalizations of walkability for older adults vs. the general population.

Methods

We conducted a systematic review of 146 empirical studies that measured walkability objectively in relation to walking-related outcomes. We compared studies focused on older adults (n = 24) and the general population (n = 122). Content analysis included the characteristics of the study design, walkability measures, spatial extent, and associations found between walkability and walking-related outcomes.

Results

In both groups of publications, the majority of studies were conducted in the US, Canada, and Europe, and largely in high-income countries. They were mostly published in health-related journals and used cross-sectional designs, operationalized walkability by using indexes, employed self-reported measures for walking-related outcomes, and found positive associations between walkability and walking outcomes. However, we observed some differences among studies focusing on older adults. Compared to studies focusing on the general population, a larger proportion of studies on older adults was conducted in the Middle East and Asia, and they used longitudinal designs, mixed methods to measure walking-related outcomes, variables related with land-use characteristics, safety from traffic and crime, and greenery, and a larger proportion found positive, as well as no associations between walkability and walking-related outcomes.

Conclusion

Although there is a promising increase in interest in older adults-focused walkability studies in the last decade, there is still a need for more studies focusing on different settings, using wider spatial extents, longitudinal designs, objective or mixed methods to collect outcome data, and specific variables and/or specially created indexes for older adults and for settings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03233-x.

The relationship between job components, neighbourhood walkability and African academics' physical activity: a post-COVID-19 context

Research to date suggests that physical activity (PA) among academics is insufficient globally. Academics in many African countries were recently required to resume work while observing social distancing protocols. Physical inactivity (PI) was, therefore, expected to increase in such academics. Interestingly, walkable neighbourhoods are resources that could discourage excessive sitting and PI in this situation. This study, therefore, assessed the moderating role of neighbourhood walkability in the relationship between core job components (i.e. on-site teaching, online teaching, research and student assessment) and PA among academics. The study adopted a cross-sectional design that utilized an online survey hosted by Google Forms to gather data. Participants were volunteer full-time academics in Nigeria, Ghana, Kenya and Tanzania. A total of 1064 surveys were analysed, with a sensitivity analysis utilized to select covariates for the ultimate hierarchical linear regression model. After controlling for the ultimate covariates (e.g. gender, education and income), PA was found to be positively associated with the job component 'research work' but negatively associated with student assessment. Neighbourhood walkability increased the positive relationship of research work with PA and reduced the negative relationship of student assessment with PA. The non-significant negative relationship between 'teaching online' and PA was made positively significant by neighbourhood walkability. We conclude that research as a job component is positively associated with PA, but online teaching is negatively associated with PA among African academics in a post-COVID-19 context.

The Effects of Neighborhood Built Environment on Walking for Leisure and for Purpose Among Older People

BACKGROUND AND OBJECTIVES

Characteristics of a neighborhood's built environment affect the walking behavior of older people, yet studies typically rely on small nonrepresentative samples that use either subjective reports or aggregate indicators from administrative sources to represent neighborhood characteristics. Our analyses examine the usefulness of a novel method for observing neighborhoods-virtual observations-and assess the extent to which virtual-based observations predict walking among older adults.

RESEARCH DESIGN AND METHODS

Using Google Street View, we observed the neighborhoods of 2,224 older people and examined how characteristics of the neighborhood built environments are associated with the amount of time older people spend walking for leisure and purpose.

RESULTS

Multilevel model analyses revealed that sidewalk characteristics had significant associations with both walking for purpose and leisure. Land use, including the presence of multifamily dwellings, commercial businesses, and parking lots were positively associated with walking for purpose and single-family detached homes were negatively associated with walking for purpose, but none of these characteristics were associated with leisure walking. Gardens/flowers were associated with walking for leisure but not purpose. Garbage/litter was not associated with either type of walking behavior.

DISCUSSION AND IMPLICATIONS

Virtual observations are a useful method that provides meaningful information about neighborhoods. Findings demonstrate how neighborhood characteristics assessed virtually differentially impact walking for leisure and purpose among older adults and are interpreted within a social-ecological model.

Relationship between county-level crime and diabetes: Mediating effect of physical inactivity

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High crime rates are associated with increased rates of type 2 diabetes.

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Area physical inactivity is an important mediator in this process.

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Over 60% of the relation between crime and diabetes was mediated by physical inactivity.

This paper assessed the extent to which physical inactivity accounts for the relationship between the crime rate and prevalence of type 2 diabetes in the United States. Using 2018 US county-level data, we compared unadjusted and adjusted prevalence of type 2 diabetes between high and low crime counties for 2,966 US counties. Average causal mediating effects of residents’ reported physical inactivity were estimated for each comparison. Counties with a higher crime rate were more likely to have higher percentages of people with type 2 diabetes than counties with a lower crime rate, even after adjusting for potential confounding factors such as racial distribution, income level, food insecurity, and neighborhood walkability (adjusted coefficient for top 40% vs. bottom 40% of crime rate distribution = 0.36; p < 0.001). Over 60% of the adjusted relationship between county-level rate of crime and type 2 diabetes was found to be mediated by physical inactivity. This study reinforces potentially overlooked public health benefits of effective anti-crime measures via improved physical activity.

Walkability Index for Elderly Health: A Proposal

Nowadays, the elderly tend to make more trips: Health benefits resulting from their daily walking routines are an important topic in the context of urban renewal processes. Many health organizations and researchers have demonstrated the influence of the urban environment on walkability levels. This article aims to design a multifactor Walkability Index for Elderly Health (WIEH), capable of associating both the adequacy level of public spaces to elderly walkability, and physical exercise benefits while walking. The methodological approach comprised two main parts: Firstly, a literature review of main reports, legislation, and scientific articles was conducted at the intersection of ‘gerontology and physical exercise’ with ‘urban design and mobility’, leading to the selection of four aging-related studies as main contributors to the design of the WIEH; and, secondly, the development of the WIEH was undertaken, based on two premises and designed according to four steps. The first premise defined three systematic areas (urban tissue, urban scene, and safety), variables, and criteria to classify the pedestrian network; and the second premise focused on slopes and stairs in public spaces. The WIEH is divided in four steps: (1) Analyzing public spaces and characterizing their quality for walking, (2) considering the existence of slopes and stairs, (3) calculating different routes for the elderly in their daily routines, or when going to points of interest, and (4) selecting the “heart-friendly route” for elderly people. Adequate walking paths for the elderly can be identified through this innovative approach, with the aim of achieving direct health benefits during their daily routines. Ultimately, the WIEH is capable of supporting decision makers and designers in creating inclusive and age-friendly spaces.

Life style activities and feeling state responses in community sample of diabetic patients in Eastern Providence Saudi Arabia

Background

The aim of the present study was to surveyed life style activity levels within diabetic patients attending the King Fahd teaching hospital of the University, Al-Khobar, Saudi Arabia, and studied their feeling towards performing different physical activity.

Methods

For this purpose, thirty Diabetic patients were randomly recruited, physically tested and handed a questionnaire to fill in.

Results

The result showed that the levels of physical activity are low and found an excessive use of cars by patients to go to public services and homes of friends and neighbors. Such unhealthy lifestyle habits encouraged patients to follow unhealthy habits such as disordered working patterns and infrequent social activity. While for those who follow healthy lifestyle pattern have better feeling while doing certain activities. For instance, patients who exercise running or jogging activities have better feeling while they rum. Moreover, patient who have healthier relaxing lifestyle pattern, have better feeling of what they do while they relax.

Conclusion

The use of exercise physiologists or physiotherapists and psychologists, education system is highly needed to explaining about the health benefits of physical activity. Physical activities should be promoted within the real context of the built environment in the eastern province, KSA.

Examining the Role of Income Inequality and Neighborhood Walkability on Obesity and Physical Activity among Low-Income Hispanic Adults

Obesity is a major public health issue affecting rising medical costs and contributing to morbidity and premature mortality. We aimed to identify factors that may play a role in obesity and physical activity at the individual and environmental/neighborhood levels. We analyzed data from an adult sample who were parents of students enrolled in a school-based health and wellness program. The sample was restricted to those who were Hispanic and whose children were on free/reduced lunch (n = 377). Dependent variables: body mass index (BMI); neighborhood walkability. Walk Score^® was used to assess neighborhood walkability. Overall, 46% of participants were obese and 31% were overweight. The median age of respondents was 34 years, and the majority were female (88%) and married (59%). Participants who resided in a census tract with a higher relative income inequality (high, OR 2.54, 90% CI 1.154-5.601; moderate-high OR 2.527, 90% CI 1.324-4.821) and those who were unmarried (OR 1.807, 90% CI 1.119-2.917) were more likely to be obese versus normal weight. Overweight individuals that resided in areas that were walkable versus car-dependent averaged more days engaging in walking for at least 30-min (p <.05). Identifying individual and neighborhood factors associated with obesity can inform more targeted approaches to combat obesity at multiple ecological levels. The importance of understanding how neighborhood characteristics influence health-related and behavioral outcomes is further reinforced with the current findings. Identifying effective strategies to engage communities and organizations in creating, implementing, adopting, evaluating, and sustaining policy and/or environmental interventions will be needed to combat the obesity epidemic.

The impact of weather on summer and winter exercise behaviors

BACKGROUND

Outdoor exercise is an enjoyable way for individuals to improve fitness, but it is dependent on weather conditions. This study examines the association between weather conditions and outdoor exercise after adjustment for age, sex, race, and socioeconomic status.

METHODS

We used data representative of American adults from the University of Michigan/Thomson Reuters June 2013 surveys of consumers (core and supplement) to investigate self-reported exercise behavior in summer and winter. Multivariate multinomial logistic regression models estimated the odds of delayed or indoor exercise compared with outdoor exercise.

RESULTS

Of the 502 respondents, 16.3% did not regularly exercise outdoors (i.e., at least once a week), and many would delay exercise both in summer (51.8%) and winter (43.9%). Individuals listing rain as the predominant adverse weather condition had 3.33 times higher odds of exercising indoors (95% confidence interval (CI): 1.34-8.28) and 3.49 times higher odds of delaying exercise (95%CI: 1.69-7.21) compared with those mentioning heat as the predominant adverse condition. Individuals for whom ice or snow was an adverse winter weather condition were more likely to delay exercise (odds ratio (OR) = 3.34; 95%CI: 1.19-9.36), compared with those concerned with cold.

CONCLUSION

This study found that race, age, and education exacerbate the negative effects of adverse weather conditions on the decision to exercise outdoors. Accordingly, any recommendation for an individual to exercise outdoors should be combined with an evaluation of the individual's outdoor environment along with strategies for the individual to continue exercising, indoors or outdoors, when adverse weather is present.

The relationship between objectively-measured attributes of the built environment and selected cardiovascular risk factors in a South African urban setting

BACKGROUND

Evidence concerning the relationship between objectively-measured attributes of the built environment with cardio-metabolic risk in populations from lower- and middle-income countries is lacking. In this paper, we describe the association between the objectively-measured built environment with body mass index, blood pressure and physical activity in adult South Africans.

METHODS

This cross-sectional study included 341 adults aged ≥35 years drawn from the Cape Town arm of the Prospective Urban Rural Epidemiology (PURE) cohort study. All Cape Town PURE participants were invited to take part in the study. Actigraph GT3X accelerometer and Geographic Information Systems were used to measure physical activity and built environment attributes (community center, shopping center and taxi rank).

RESULTS

In age and sex adjusted models (reference 500 m), access to community centers (1000 m) was positively related to body mass index [beta 4.70 (95%CI: 2.06 to 7.34)] and diastolic blood pressure [4.97 (0.00 to 9.95)]. Distance from a community center (1600 m) was positively related to diastolic blood pressure [6.58 (1.57 to 11.58)] and inversely with moderate-to-vigorous physical activity [- 69.30 (- 134.92 to - 3.70)]. Distance to a shopping center (1600 m) was positively related to body mass index [4.78 (1.11 to 8.45)] and shopping center (1000 m) was positively related to systolic blood pressure respectively [76.99 (0.03 to 83.95)].

CONCLUSION

Distance to community and shopping centers were significantly associated with BMI, systolic, diastolic blood pressure and moderate-to-vigorous physical activity. Future research should include multiple aspects of built environment variables in order to provide for a broader understanding of their effect on cardiovascular risk profile of African populations.

Exercise and Diabetes: A Narrative Review

Persons with diabetes might experience significant benefits through regular exercise. Not unlike the general population, those with diabetes could also lack motivation to participate in an exercise program. Often, those treating persons with diabetes lack training and/or interest in exercise prescription and are therefore unable to provide the needed information and encouragement. In many cases, reluctance to exercise could result from an inability to find an enjoyable exercise activity. Attempts to find activities that, not only provide effective aerobic challenges, but are also enjoyable to participate in are fraught with difficulty. Three electronic databases were searched in January 2017. Evidence for the merits of exercise for those with diabetes was robust. Numerous reports have addressed the degree of noncompliance to exercise recommendations and the barriers reported for this nonadherence. Additional studies concluded that most medical providers are deficient in formal training in the prescription of an exercise program. Newer studies are evaluating the effects of exercise and vitamin D supplementation and their interplay with diabetic peripheral neuropathy and ulceration. Exercise confers remarkable benefits to those with diabetes; however, the challenges to compelling patients with diabetes to exercise are formidable. An improved focus on exercise prescription and related motivation during provider training must be undertaken.

Using Walk Score™ and Neighborhood Perceptions to Assess Walking Among Middle-Aged and Older Adults

We aimed to determine the relationship between neighborhood characteristics (walkability, cohesion/safety) and recommended activity levels among community-dwelling middle-aged and older adults. Subjective and objective data on 394 individuals aged ≥50 years were used to assess the likelihood of walking ≥150 min/week. Environmental factors associated with a greater likelihood of any walking ≥150 min/week included living in a neighborhood with high perception of cohesion/safety versus low, living in walkable areas versus car-dependent, and living in an area with a low-moderate median income versus the lowest. Middle-aged and older adults were more likely to walk ≥150 min/week in a walkable, perceived safe/cohesive neighborhood. Identifying neighborhood factors associated with promoting walking among this population can enable stakeholders (e.g., researchers, planners, and policy makers) to direct interventions focusing on the built environment.

Place matters: A longitudinal analysis measuring the association between neighbourhood walkability and walking by age group and population center size in Canada

This study examined the influence of walkability on walking behaviour and assessed whether associations varied according to life-stage and population center (PC) size. Walkability scores were obtained for the six-digit postal codes of residential neighbourhoods of 11,200 Canadians, who participated in biennial assessments of the National Population Health Survey from 1994 to 2010. Participants were stratified by age-group. Mixed-effects logistic regression models were used to estimate the influence of cumulative exposure to neighborhood walkability on utilitarian and exercise walking by PC size and life-stage. Associations of neighbourhood walkability with utilitarian and exercise walking varied according to age-group and PC size. Exposure to high walkable neighborhoods was associated with utilitarian walking in younger and older adults in all PC sizes, except for older adults living in a medium PC. Living in a highly walkable neighborhood in a large PC was associated with walking for exercise in younger (OR: 1.42; 95%CI: 1.20-1.67) and older adults (OR: 2.09; 95%CI: 1.51-2.89). Living in highly walkable neighbourhood in a medium PC was associated with walking for exercise in older adults (OR: 1.62; 95%CI: 1.15-2.29). These results emphasize the need to consider the size and nature of every community, and the age-group of a population when implementing strategies to promote walking.

Direct and indirect effects of neighborhood factors and self-care on glycemic control in adults with type 2 diabetes

AIM

To determine whether neighborhood factors have direct or indirect effects, via self-care behaviors on glycemic control.

METHODS

Adult patients with type 2 diabetes were recruited from an academic medical center and Veterans Affairs Medical Center in the southeastern United States. Confirmatory factor analysis was used to create latent variables for neighborhood factors and diabetes self-care behavior. Structural equation modeling was used to test direct and indirect effects between neighborhood factors and glycemic control as assessed by HbA1c levels.

RESULTS

CFA yielded four latent variables for neighborhood factors (neighborhood violence, access to healthy food, social support, and neighborhood aesthetics) and one latent variable diabetes self-care. We found that social support (β=0.28, z=4.86, p<0.001) and access to healthy foods (β=-0.17, z=-2.95, p=0.003) had direct effects on self-care; self-care (β=-0.15, z=-2.48, p=0.013) and neighborhood aesthetics (β=0.12, z=2.19, p=0.03) had direct effects on glycemic control; while social support (β=-0.04, z=-2.26, p=0.02) had an indirect effect on glycemic control via self-care.

CONCLUSION

This study showed that self-care behaviors and neighborhood aesthetics have direct effects on glycemic control, social support and access to health foods had direct effects on self-care, and social support had an indirect effect on glycemic control via self-care.

Does territoriality modify the relationship between perceived neighborhood challenges and physical activity? A multilevel analysis

PURPOSE

Individuals who perceive more neighborhood challenges are less physically active. Territoriality, an observable positive marker of social presence and defensible space in the neighborhood, may influence the association between neighborhood challenges and physical activity (PA). We hypothesized that greater territoriality would reduce the negative effects of neighborhood challenges on PA levels.

METHODS

Data were collected by the Healthy Environments Partnership in an urban Midwestern city. Multilevel regressions were used to test associations in a sample of 696 white, black, and Hispanic adults older than 25 years.

RESULTS

Territoriality moderated associations between residents' perceptions of neighborhood challenges and PA. Contrary to our hypothesis, individuals who perceived more neighborhood challenges and lived in areas with more territoriality markers (e.g., buildings with decorations, buildings with security signage, and neighborhood watch signs) were less physically active than other respondents (b = -2.41, standard error = 0.84, P < .01).

CONCLUSIONS

Our findings suggest that associations between perceived neighborhood challenges and PA are shaped by the context in which the individual lives. Our study provides empirical evidence that individual perceptions and observed neighborhood characteristics are joint contributors to PA and suggest the need for continued research to characterize the complexity of individual and contextual factors that contribute to PA.