Determinants of Walking among Middle-Aged and Older Overweight and Obese Adults: Sociodemographic, Health, and Built Environmental Factors

Effectiveness of a supervised group-based walking program on physical, psychological and social outcomes among older adults: a randomised controlled trial protocol

INTRODUCTION

To minimise adverse health events among older adults, physical activity (PA) is considered one of the most fundamental and effective forms of lifestyle. Therefore, an urgent effort to promote a physically active lifestyle among our older adults is needed, in which walking could be a better choice, especially for mass promotion. Besides, the types of PA interventions were also shown to affect their effectiveness on older adults' psychosocial outcomes. Hence, the overall aim of the project is to examine the effectiveness of supervised group-based walking intervention by comparing it with unsupervised group-based walking and unsupervised individual-based walking interventions on improving physical, psychological and social outcomes among older adults in Hong Kong.

METHODS AND ANALYSIS

The research will conduct a four-group (supervised group-based, unsupervised group-based walking, unsupervised individual-based, control group), double-blind, randomised control trial, targeting 184 older adults in Hong Kong. The primary outcomes will be measured by participants' changes in resting heart rates, body compositions, resting blood pressures, walking performance, loneliness, perceived social support and PA enjoyment. The results will be analysed using repeated analysis of variance and one-way analysis of covariance, as well as by conducting in-depth interviews with selected participants. Also, the outcomes of the research will be used as references for designing an effective walking operation manual for promoting healthy ageing among older adults in the community.

ETHICS AND DISSEMINATION

The current study involves human participants, and the research protocol has been approved by the research ethics committee at Hong Kong Baptist University (Ref: R2022-2023-0013). All participants will be provided with written informed consent to participate. The outcomes of the intervention protocol will be disseminated through manuscript publications.

TRIAL REGISTRATION NUMBER

The trial is registered at the ClinicalTrials.gov PRS (Trial ID: NCT05907252; date of first posted: 16 June 2023).

Enhancing Physical and Psychosocial Health of Older Adults in Saudi Arabia through Walking: Comparison between Supervised Group-Based and Non-Supervised Individual-Based Walking

Walking is widely recognized as one of the most common and effective forms of physical activity, particularly for older adults. This study examined the comparative effects of two types of walking interventions, including supervised group-based intervention (SGBI) and non-supervised individual-based intervention (NSIBI), on frailty syndrome, cognitive functions or skills, and health-related quality of life among sedentary older Saudi individuals. A 15-week double-blinded, randomized controlled trial (RCT) including three groups (two were intervention groups while the other was the control group) was conducted among older adults who were inactive to examine the effect of different forms of walking interventions on frailty syndrome, cognitive functions, and health-related quality of life. A total of 107 participants, including 65 males and 42 females, were divided into three groups, which include SGBI, NSIBI, and the control group. Frailty syndrome was measured using the physical performance test (PPT), while cognitive function and health-related quality of life were assessed using the Mini-mental State Examination (MMSE) and the Short Form 36 (SF 36) health survey questionnaire. One-way repeated measures analysis of variance (ANOVA) and one-way analysis of covariance (ANCOVA) with the pre- and post-tests were performed for within- and between-group differences. while post-test data for the control group participants were absent due to the change in elderly center regulation, and they were excluded from the analysis. Hence, the comparison was stated only between the intervention groups. Both of the intervention groups (SGBI and NSIBI) showed significant within-subject differences in the Physical Function subscale of the health-related quality of life scale only, with F(1,20) = 23.03, p < 0.001, and F(1,18) = 27.22, p < 0.001, respectively. On the other hand, the Physical Performance Test revealed significant [F(2,51) = 9.21, p < 0.001] between-group differences in the post-test based on the baseline values. In addition, the average step count of older adults was increased from 4000 steps per session to around 7000 steps per session in the intervention group. The average heart rate of the NSIBI group did not show a visible change, and the resting heart rate of both groups showed a slightly declining trend throughout the intervention period. The walking intervention significantly increased participants' physical function, which is a component of health-related quality of life and physical performance (frailty level), along with average daily step counts for older adults in Saudi Arabia. Regular engagement in the recommended level of walking is strongly advisable for Saudi Arabian older adults to maintain their overall quality of life at this stage.

The effects of walking on frailty, cognitive function and quality of life among inactive older adults in Saudi Arabia: a study protocol of randomized control trial by comparing supervised group-based intervention and non-supervised individual-based intervention

BACKGROUND

Kingdom of Saudi Arabia (KSA) demographics are also changing with the increase in life expectancy in the country and the rise in the number of older Saudi Arabians. Saudi Arabia has a higher rate of physically inactive people, and most of them are between the ages of 55-64. Walking is one of the most prevalent forms of physical activity in Saudi Arabia and the study showed that most people prefer walking for recreational and health benefits. Therefore, the purpose of the proposed study is to compare the effects of supervised group-based walking and non-supervised individual-based walking interventions on frailty, cognitive function and quality of life among inactive older adults in Saudi Arabia.

METHOD

This study will apply a three-group (2 intervention groups and 1 control group), double-blinded, randomized controlled trial (RCT) to examine the effect of different forms of walking interventions on Saudi Arabia older adults' frailty, cognitive function and quality of life immediately after a 16-week intervention, as well as the residual effects 12 weeks after completion of the interventions.

DISCUSSION

This study aims to determine whether supervised group walking and non-supervised individual walking lead to different effects. Given the limited evidence in the literature regarding Saudi Arabia older adults' physical fitness and health, it is worthwhile to explore the effect of walking, as well as the forms of walking on improving the overall physical fitness and psychological status of older adults in Saudi Arabia. The findings of the current study could also create awareness of the government and the general public in Saudi Arabia of the ageing problems and the effective ways of achieving better intervention results.

TRIAL REGISTRATION

The trial is registered at the ClinicalTrials.gov PRS (Trial ID: NCT05151575; Date of first posted: 12/07/2021).

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 Effect of High-Density Built Environments on Elderly Individuals' Physical Health: A Cross-Sectional Study in Guangzhou, China

The built environment refers to the objective material environment built by humans in cities for living and production activities. Existing studies have proven that the built environment plays a significant role in human health, but little attention is paid to the elderly in this regard. At the same time, existing studies are mainly concentrated in Western developed countries, and there are few empirical studies in developing countries such as China. Based on POI (point of interest) data and 882 questionnaires collected from 20 neighborhoods in Guangzhou, we employ multilevel linear regression modeling, mediating effect modeling, to explore the path and mechanism of the impact of the built environment on elderly individuals' physical health, especially the mediating effects of physical and social interaction activity. The results show that the number of POIs, the distance to the nearest park and square, and the number of parks and squares are significantly positively correlated with the physical health of the elderly, while the number of bus and subway stations and the distance to the nearest station are significantly negatively correlated. Secondly, physical activity and social networks play a separate role in mediating the effect of the built environment on elderly individuals' physical health. The results enrich the research on the built environment and elderly individuals' health in the context of high-density cities in China and provide some reference basis for actively promoting spatial intervention and cultivating a healthy aging society.

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.

Measuring the association of objective and perceived neighborhood environment with physical activity in older adults: challenges and implications from a systematic review

BACKGROUND

A supportive environment is a key factor in addressing the issue of health among older adults. There is already sufficient evidence that objective and self-reported measures of the neighborhood environment should be taken into account as crucial components of active aging, as they have been shown to influence physical activity; particularly in people aged 60+. Thus, both could inform policies and practices that promote successful aging in place. An increasing number of studies meanwhile consider these exposures in analyzing their impact on physical activity in the elderly. However, there is a wide variety of definitions, measurements and methodological approaches, which complicates the process of obtaining comparable estimates of the effects and pooled results. The aim of this review was to identify and summarize these differences in order to emphasize methodological implications for future reviews and meta analyzes in this field and, thus, to create a sound basis for synthesized evidence.

METHODS

A systematic literature search across eight databases was conducted to identify peer-reviewed articles examining the association of objective and perceived measures of the neighborhood environment and objectively measured or self-reported physical activity in adults aged ≥ 60 years. Two authors independently screened the articles according to predefined eligibility criteria, extracted data, and assessed study quality. A qualitative synthesis of the findings is provided.

RESULTS

Of the 2967 records retrieved, 35 studies met the inclusion criteria. Five categories of methodological approaches, numerous measurement instruments to assess the neighborhood environment and physical activity, as well as several clusters of definitions of neighborhood, were identified.

CONCLUSIONS

The strength of evidence of the associations of specific categories of environmental attributes with physical activity varies across measurement types of the outcome and exposures as well as the physical activity domain observed and the operationalization of neighborhood. The latter being of great importance for the targeted age group. In the light of this, future reviews should consider these variations and stratify their summaries according to the different approaches, measures and definitions. Further, underlying mechanisms should be explored.

Neighborhood built and social environment and meeting physical activity recommendations among mid to older adults with joint pain

Arthritis is a leading cause of disability in the United States, with the most efficacious treatments being physical activity (PA). Arthritis patients are less likely to meet PA recommendations and the neighborhood environment may play a role. This study examines the effect of neighborhood walkability and social cohesion on PA among arthritis patients in a sample of US adults. This cross-sectional study used 2015 National Health Interview Survey data. Eligible participants were age ≥45 years, had arthritis, recent leg-joint pain and complete data. Walkability was based on 6 questions regarding amenities and destinations that promote walking. Social cohesion was based on 4 validated questions. Meeting PA was defined as 150 min/week. Chi-squared testing and logistic regression determined associations between neighborhood environment and PA, including interaction between social cohesion and walkability. The final unweighted sample included 3,826 participants with mean age 64.6 years (SE = 0.26), 61.8% female and 78.1% non-Hispanic White. In adjusted, weighted analysis, not, slightly, and moderately-walkable neighborhoods all had lower odds of meeting PA recommendations verses highly-walkable neighborhood (OR = 0.61[95% CI 0.41–0.92], OR = 0.65[95% CI 0.50–0.85], OR = 0.75[95% CI 0.59–0.97], respectively). Social cohesion was independently associated with decreased odds of meeting PA guidelines (p = 0.003). No interaction with walkability was found (p = 0.405). Less than a highly-walkable neighborhood and lower social cohesion were independently associated with decreased odds of meeting PA recommendations among adults with arthritis and recent joint pain. Since walking is one of the most effective treatments for arthritis, clinicians should be sensitive to barriers patients may perceive to walking.

The Role of Built Environment on Health of Older Adults in Korea: Obesity and Gender Differences

This study examines the effect of the built environment on obesity in older adults, taking into consideration gender difference. In this regard, we ask two questions: (1) How does the built environment affect obesity in older adults? (2) Is there a gender difference in the effect of the built environment? To examine the research questions, this study uses the 2015 Korean National Health and Nutrition Survey and geographically weighted regression (GWR) analysis. The empirical analyses show that environmental factors have stronger effects on local obesity rates for older men than for older women, which indicates a gender difference in obesity. Based on these findings, we suggest that public health policies for obesity should consider the built environment as well as gender difference.

Translating Urban Walkability Initiatives for Older Adults in Rural and Under-Resourced Communities

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.

Restricted Social Engagement among Adults Living with Chronic Conditions

Background: Social engagement is key to health and quality of life. Little is known about social engagement patterns of middle-aged and older adults who live with one or more chronic illnesses. This study investigated social engagement restrictions among middle-aged and older adults with chronic conditions and factors associated with these restrictions. Methods: Cross-sectional representative data from the National Council on Aging Chronic Care Survey were examined for relationships between social engagement restrictions and chronic conditions, health status, support, quality of life implications, self-care barriers, caregiving, and demographics. Associations were tested using bivariate analyses and binary logistic regression. Results: Participants were 793 middle-aged (age 44-64) and older adults (age 65+) with one or more chronic conditions. Factors associated with social engagement restrictions included having higher education, receiving care, having more physician visits and hospitalizations, being disabled, being unemployed, and having higher Emotional and Physical Problems Scale scores. Conclusions: Findings reveal the prevalence of social engagement restrictions among middle-aged and older adults with chronic conditions. Results highlight the importance of promoting research, assessments, and interventions to increase social engagement among this aging population.