Physical environmental factors related to walking and cycling in older adults: the Belgian aging studies

[Indice du potentiel de participation sociale des Québécois âgés : cartographie des inégalités des zones métropolitaines, urbaines et rurales]

Afin de mieux comprendre la distribution géographique des facilitateurs et des obstacles à la participation sociale des Québécois âgés, cette étude visait à documenter l'Indice du potentiel de participation sociale (IPPS) selon les zones métropolitaines, urbaines et rurales. Des analyses de données secondaires, dont l'Enquête transversale sur la santé des collectivités canadiennes, ont permis de développer et de cartographier un indice composé de facteurs environnementaux associés à la participation sociale, pondérés par une analyse factorielle. En zones métropolitaines, l'IPPS était supérieur au centre qu'en périphérie, compte tenu d'une concentration accrue d'aînés et des transports. Bien qu'atténuée, la configuration était similaire en zones urbaines. En zone rurale, un IPPS élevé était associé à une concentration d'aînés et un accès aux ressources accru, sans configuration spatiale. Pour favoriser la participation sociale, l'IPPS soutient que les transports et l'accès aux ressources doivent respectivement être améliorés en périphérie des métropoles et en zone rurale.

The impact of street greenery on active travel: a narrative systematic review

Background

Street greenery may have a profound effect on residents' active travel (AT), a mode of transportation involving walking and cycling. This study systematically reviewed the scientific evidence on the effects of street greenery on active travel.

Methods

A comprehensive search was performed using keywords and references in PubMed, Web of Science, Scopus, and Cochrane Library. The review included studies that met the following criteria: (1) Study design: experimental studies, cross sectional studies, (2) Participants: individuals of all ages, (3) Exposure variables: street greenery, including street vegetation (e.g., trees, shrubs, and lawns), (4) Outcomes: active travel behaviors (walking, cycling), (5) Article type: peer-reviewed articles, (6) Search time window: from the inception of relevant electronic literature database until 21 June 2023, (7) Geographic scope: worldwide; (8) Language: articles in English.

Results

Twenty-six cross-sectional studies met the inclusion criteria and were analyzed. These studies employed objective metrics for assessing street greenery and varied methodologies to measure AT, including 14 using subjective measurements (like self-reported surveys), 10 using objective data (such as mobile app analytics), and two studies combined both approaches. This review identifies a generally positive impact of street greenery on active travel in various aspects. However, the extent of this influence varies with factors such as temporal factors (weekdays vs. weekends), demographic segments (age and gender), proximity parameters (buffer distances), and green space quantification techniques. Street greenness promotes active travel by enhancing environmental esthetics, safety, and comfort, while also improving air quality, reducing noise, and fostering social interactions. In addition, the study suggests that variables like weather, seasonality, and cultural context may also correlate with the effectiveness of street greenery in encouraging active travel.

Conclusion

Street greenery positively influences active travel, contributing to public health and environmental sustainability. However, the findings also indicate the need for more granular, experimental, and longitudinal studies to better understand this relationship and the underlying mechanisms. These insights are pivotal for urban planners and policymakers in optimizing green infrastructure to promote active transportation, taking into account local demographics, socio-economic factors, and urban design.

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

OBJECTIVE

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

DATA SOURCES

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

STUDY SECTION

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

DATA EXTRACTION

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

DATA SYNTHESIS

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

CONCLUSIONS

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

Neighborhood Socioeconomic Status, Green Space, and Walkability and Risk for Falls Among Postmenopausal Women: The Women's Health Initiative

PURPOSE

This study estimated associations between neighborhood socioeconomic status (NSES), walkability, green space, and incident falls among postmenopausal women and evaluated modifiers of these associations, including study arm, race and ethnicity, baseline household income, baseline walking, age at enrollment, baseline low physical functioning, baseline fall history, climate region, and urban-rural residence.

METHODS

The Women's Health Initiative recruited a national sample of postmenopausal women (50-79 years) across 40 U.S. clinical centers and conducted yearly assessments from 1993 to 2005 (n = 161,808). Women reporting a history of hip fracture or walking limitations were excluded, yielding a final sample of 157,583 participants. Falling was reported annually. NSES (income/wealth, education, occupation), walkability (population density, diversity of land cover, nearby high-traffic roadways), and green space (exposure to vegetation) were calculated annually and categorized into tertiles (low, intermediate, high). Generalized estimating equations assessed longitudinal relationships.

RESULTS

NSES was associated with falling before adjustment (high vs. low, odds ratio, 1.01; 95% confidence interval, 1.00-1.01). Walkability was significantly associated with falls after adjustment (high vs. low, odds ratio, 0.99; 95% confidence interval, 0.98-0.99). Green space was not associated with falling before or after adjustment. Study arm, race and ethnicity, household income, age, low physical functioning, fall history, and climate region modified the relationship between NSES and falling. Race and ethnicity, age, fall history, and climate region modified relationships between walkability and green space and falling.

CONCLUSIONS

Our results did not show strong associations of NSES, walkability, or green space with falling. Future research should incorporate granular environmental measures that may directly relate to physical activity and outdoor engagement.

Cycling in older adults: a scoping review

Introduction

Regular physical activity provides many health benefits to older adults. As a well-known form of physical activity, cycling can be an appropriate means for older people to meet WHO recommendations and to improve their health. In addition, cycling can help to protect the environment and reduce greenhouse gas emissions. The primary aim of this scoping review is to identify the currently available scientific evidence and gaps of research in this field.

Methods

A systematic search in seven databases resulted in 7,192 studies. After the exclusion of duplicates, studies were screened by two independent reviewers in a two-stage process. Based on previously defined inclusion criteria, 123 studies were included. Data extraction was based on a descriptive analytical method, and seven categories for the main topics of studies were developed. Data were extracted by three reviewers to analyze different characteristics of included articles such as age range, study design, data type, gender, type of bicycle, and country of origin.

Results

The included studies covered the following topics: (1) traffic safety, (2) cycling as physical activity or for transport, (3) health benefits, (4) environmental factors, (5) facilitators and barriers, (6) application of technology and (7) promotion of cycling. Results show that the majority of studies were performed in both younger (60-79 years) and older (80+ years) adults. Most studies had an observational study design, used conventional bicycles, and were based on quantitative methods. Researchers from the United States, Netherlands, and Japan published the highest number of studies related to cycling.

Discussion

Traffic safety was the most prevalent focus of the included studies. Gaps were identified with regard to studies focusing on the promotion of cycling, application of technology, as well as facilitators and barriers of cycling. While research on traffic safety should continue to be a high priority for public health, potentially more research should focus on how to get older people to bicycle more. This is warranted by the proven individual and planetary health benefits of cycling and the urgency of combating climate change.

Pedestrians' perceptions of route environments in relation to deterring or facilitating walking

Background

Every walk takes place in a route environment, and it can play an important role in deterring or facilitating walking, and will always affect the environmental unwell-well-being of pedestrians. The aim of this study is to illuminate which the important route environmental variables are in this respect. The focus is, therefore, on pedestrians' perceptions of route environmental variables and how they relate to overall appraisals of route environments as hindering-stimulating for walking and unsafe-safe for reasons of traffic.

Methods

Commuting pedestrians in the inner urban area of Stockholm, Sweden (n = 294, 49.5 ± 10.4 years, 77% women), were recruited via advertisements. They evaluated their commuting route environments using a self-report tool, the Active Commuting Route Environment Scale (ACRES). Correlation, multiple regression, and mediation analyses were used to study the relationships between the variables and the outcome variables.

Results

Aesthetics and greenery appear to strongly stimulate walking, whereas noise, a proxy for motorized traffic, hinders it. Furthermore, aesthetics is positively related to traffic safety, whereas conflicts have the opposite role. Conflicts is an intermediate outcome, representing several basic environmental variables, some of which were directly and negatively related to unsafe-safe traffic.

Conclusion

Route environmental variables appear to be potent factors in deterring or facilitating walking. This knowledge is of importance for policymakers and urban planners when designing route environments with the aim of attracting new pedestrians, and simultaneously stimulating those who already walk to keep on.

Pedestrians' Perceptions of Motorized Traffic Variables in Relation to Appraisals of Urban Route Environments

It is important to examine how motorized traffic variables affect pedestrians along a gradient from rural to inner urban settings. Relations between pedestrians' perceptions of four traffic variables and appraisals of route environments as hindering-stimulating for walking as well as unsafe-safe for reasons of traffic, were therefore studied in the inner urban area of Stockholm, Sweden (n = 294). The pedestrians rated their perceptions and appraisals with the Active Commuting Route Environment Scale (ACRES). Correlation, multiple regression, and mediation analyses were used to study the relationships between the traffic variables and the outcome variables. Noise related negatively to both hindering-stimulating for walking, and to unsafety-safety for traffic reasons. Vehicle speed related negatively to unsafety-safety for traffic reasons. Furthermore, vehicle speed protruded as an important origin of the deterring effects of traffic among those who commute by foot. The study shows the value of both partial and simultaneous analyses of the effect of all four traffic variables in relation to outcome variables relevant for walking.

Walking and perception of green space among older adults in Japan: subgroup analysis based self-efficacy

Self-efficacy is the key factor for promoting physical activity. Older adults with low self-efficacy tend to be physical inactive than those with high self-efficacy, and an approach is needed to promote physical activity. Among several approaches, increasing the perception of green space may be an effective approach for low self-efficacy not high self-efficacy, but no study has investigated. This study investigated the association between walking and perception of green space among older adults with high and low self-efficacy, respectively. We conducted a cross-sectional study among 204 community-dwelling older adults (mean age = 78.3 years, 62.3% females). Using the median split, the participants were divided into high and low self-efficacy groups based on the median score of 12. Walking was measured using the International Physical Activity Questionnaire and 'more walking' was defined as ≥150 min of walking time per week. Perception of green space was measured using an 8-item questionnaire. We performed logistic regression analysis to investigate the association between walking and perception of green space adjusted for age, gender, years of education, living with someone and income level. For all participants, 94 participants (46.1%) fell under low self-efficacy. After adjustment, higher perception of green space is associated with more walking among older adults with low self-efficacy [adjusted odds ratio (aOR) = 1.07, 95% confidence interval (CI) = 1.00-1.15], but not among those with high self-efficacy (aOR = 1.09, 95% CI= 0.99-1.20). To increase perception of green space, experts should design/improve green spaces considering beneficiaries' characteristics.

Associations Between Local Area Deprivation and Physical Activity Participation in People with Cognitive Impairment in the North East of England

BACKGROUND

Promoting physical activity, such as habitual walking behaviors, in people with cognitive impairment may support their ability to remain independent with a good quality of life for longer. However, people with cognitive impairment participate in less physical activity compared to cognitively unimpaired older adults. The local area in which people live may significantly impact abilities to participate in physical activity. For example, people who live in more deprived areas may have less safe and walkable routes.

OBJECTIVE

To examine this further, this study aimed to explore associations between local area deprivation and physical activity in people with cognitive impairment and cognitively unimpaired older adults (controls).

METHODS

87 participants with cognitive impairment (mild cognitive impairment or dementia) and 27 older adult controls from the North East of England were included in this analysis. Participants wore a tri-axial wearable accelerometer (AX3, Axivity) on their lower backs continuously for seven days. The primary physical activity outcome was daily step count. Individuals' neighborhoods were linked to UK government area deprivation statistics. Hierarchical Bayesian models assessed the association between local area deprivation and daily step count in people with cognitive impairment and controls.

RESULTS

Key findings indicated that there was no association between local area deprivation and daily step count in people with cognitive impairment, but higher deprivation was associated with lower daily steps for controls.

CONCLUSION

These findings suggest that cognitive impairment may be associated with lower participation in physical activity which supersedes the influence of local area deprivation observed in normal aging.

Odds of self-reported minor cycle crashes with conventional and electric assisted cycles adjusted for cycling frequency in Dutch and Belgian adults a retrospective study

BACKGROUND

Cycling for transportation and recreation is gaining in popularity, especially in older age groups. The rise in electric assisted cycles (EAC) may also have a role to play in this. With an increase in the number of cyclists comes an increase in the prevalence of cycle crashes. However, there is a lack of knowledge on EAC crashes and crash studies including cycle use data. An important question is also whether the high number of serious road injuries among older cyclists, is due to increased risk or more serious consequences in the event of a crash.

STUDY AIM

To compare the odds of reporting a cycle crash on a conventional (CC) against electrically assisted cycle (EAC), while controlling for age, gender, BMI, impairments while cycling, cycling frequency and region of residence.

METHODS

A 12-month retrospective cross-sectional survey-based study, including male and female cyclists aged 40+ years, was conducted in Belgium and the Netherlands. Socio-demographics, physical and mental impairments while cycling (such as lower reaction time), crash details and cycling frequency data were collected. Cyclists were grouped into CC, EAC or both (CC + EAC) based on the type of cycle they used during the study period. Logistic regression models were used to calculate the odds of reporting a cycle crash. Main and interaction effects were studied.

RESULTS

1,919 cyclists were included in the data analysis (63.2 ± 11.1 years; 50% women). 319 (17% of the total sample) cyclists reported a crash in the previous 12 months, of which 36% were EAC crashes. Those reporting a crash were significantly younger compared to those not reporting a crash. The following significant main effects were observed: those cycling on an EAC had a higher odds of reporting a cycle crash compared to those cycling on a CC (OR = 1.41, 95% CI = 1.01-1.97); cyclists in the category average and high on mental impairments while cycling had a higher odds of reporting a cycle crash compared to those in the category low (OR = 1.72, 95% CI = 1.23-2.40 and OR = 3.49, 95% CI = 2.51-4.90, respectively); higher cycling frequency is related to higher odds of reporting a cycle crash (OR = 3.25, 95% CI = 2.25-4.90). A significant interaction effect was observed between age category and gender (OR = 1.93, 95% CI = 1.15-3.26). Post-hoc tests revealed that men in the younger age category (40-64 years) had the highest probability (18.95%) of reporting a cycle crash, whereas men in the oldest age category (65+ years) had the lowest probability (9.99%) of reporting a cycle crash. No significant difference between age categories in women was observed.

CONCLUSION

This study indicates that within a cohort of middle aged and older adults living in regions with high to low cycling modal shares, cycle type, mental impairments while cycling, cycling frequency and region of residence play a significant role in the odds of reporting a (minor) cycle crash. Men in the age category 40-64 years have a significantly higher probability of reporting a cycle crash compared to men of 65+ years. Safety campaigns and instructions should pay particular attention to men in the age category 40-64 years and those with a mental impairment while cycling.

Individual characteristics, perceived neighborhood, and walking for transportation among older Brazilian people residing in a large urban area

This study aimed to investigate the association of individual and environmental characteristics with walking for transportation among older Brazilian people living in a large urban area. Data from 825 participants (≥ 60 years) from a multistage household survey in Belo Horizonte, Brazil, were used. Walking for transportation was evaluated using the International Physical Activity Questionnaire. The environmental variables included six perceived neighborhood scales (walkability, quality of services, physical disorder, safety, social disorder, and social cohesion). A Poisson regression analysis with robust variance was performed. The walking for transportation was significantly associated with walkability scale, lower family income (up to four minimum wages), very good/good self-rated health, and high social participation. Our results suggest that promoting adequate conditions for walkability in urban areas, expanding the opportunities for social participation, and improving general health is essential to increase walking levels for transportation among this older Brazilian population.

Correlates and determinants of transport-related physical activity among adults: an interdisciplinary systematic review

INTRODUCTION

Transport-related physical activity (TRPA) has been identified as a way to increase physical activity due to its discretionary and habitual nature. Factors thought to influence TRPA span multiple disciplines and are rarely systematically considered in unison. This systematic review aimed to identify cross-sectional and longitudinal factors associated with adult TRPA across multiple research disciplines.

METHODS

Using four electronic databases, a systematic search of English, peer-reviewed literature from 2010 - 2020 was performed. Studies quantitatively examining factors associated with the outcome of adult TRPA were eligible.

RESULTS

Seventy-three studies (n = 66 cross-sectional; n = 7 longitudinal) were included, cumulatively reporting data from 1,278,632 observations. Thirty-six factors were examined for potential association with TRPA and presented in a social-ecological framework: individual (n = 15), social (n = 3), and environmental (n = 18). Seven factors were found to be consistently associated with higher adult TRPA: lower socio-economic status, higher self-efficacy, higher social normalization, lower distance of travel, higher destination concentration, more streetlighting, and higher public transportation frequency with a greater number of terminals near route start and endpoints.

CONCLUSIONS

This is the first comprehensive compilation of the correlates and determinants of adult TRPA. Seven individual, social, and environmental factors demonstrated consistent associations with TRPA. Models formed using these factors may facilitate more effective promotion of TRPA. There is a lack of longitudinal studies as well as studies assessing cognitive/attitudinal and social factors, highlighting gaps for further research. Those developing policies and strategies targeting TRPA need to consider a range of factors at the individual, social, and environmental level to maximise the likelihood of effectiveness.

The relationship between perceived built environment and cycling or e-biking for transport among older adults–a cross-sectional study

The built environment plays a key role in promoting active mobility for healthy aging. Encouraging active mobility among older adults, however, can be especially challenging in more rural areas where distances tend to be longer and infrastructure is favoring car traffic. The association of older adults’ perception of attributes of the built environment with cycling and e-biking for transport was investigated. The potential moderating effects of age, sex, and mobility impairments were explored. A cross-sectional survey was conducted in towns and communities of <100,000 inhabitants, including 2,144 participants (mean age: 74; 53% men). Three different cycling outcomes (any cycling/e-biking, frequency (≥3 days/week) and amount (minutes/week)) were analyzed among all cyclists and e-bike users separately, resulting in six dependent variables. The impact of ten environmental attributes on these outcomes was analyzed in separate models. Overall, street connectivity, and the proximity and number of destinations were most important. Only street connectivity and traffic safety were related to minutes cycling or e-biking per week. Cycling amount was higher overall for e-biking but fewer environmental attributes showed an association compared to any cycling, regardless of bicycle type. Traffic safety was not associated with four out of the six cycling outcomes and was inversely associated with minutes cycling or e-biking. Density was not related to any of the variables investigated. Several interaction effects of sex, age, and mobility impairments were found. Further research is needed on environmental attributes influencing e-bike use, the most important types of destinations, and a more differentiated assessment of perceived traffic safety in older adults.

Environmental Correlates of Physical Activity, Sedentary Behavior, and Self-Rated Health in Chronic Obstructive Pulmonary Disease

PURPOSE

Physical activity (PA) predicts important health outcomes in chronic obstructive pulmonary disease (COPD). In the general population, environmental factors have the potential to influence PA; however, data are limited in this clinical population. Therefore, we sought to investigate associations between the environment and PA, sedentary behavior, and self-rated health in COPD.

METHODS

Sociodemographic, PA, sedentary behavior, and self-rated health data were collected from a prospective cohort of 418 individuals with COPD (65% female; 58 ± 8 yr), while environmental data were drawn from a national environmental data repository and individually matched to participant postal code. Environmental variables included social and material deprivation, urban form index, surrounding greenness, and air quality (concentrations of air pollution for fine particles, nitrogen dioxide, ozone, and sulphur dioxide). Logistic and multivariate linear regression models were used to investigate the strongest environmental predictors.

RESULTS

The models showed a statistically significant negative correlation between PA level and ozone pollution (P = .023; adjusted OR = 0.85: 95% CI, 0.74-0.98). Urban form index was also significantly associated with sedentary behavior (β = 0.113; t value = 1.71; P = .011). Self-rated health was significantly positively correlated with PA level (P = .006; adjusted OR = 2.22: 95% CI, 1.25-3.94), and significantly inversely correlated with sedentary behavior (β = -0.159; t value =-2.42; P = .016).

CONCLUSION

These new data may identify barriers to PA and assist clinicians in the prescription of exercise for individuals living with COPD.

Destinations fostering older adults' walking for transport: a cross-sectional study from Germany

Background

Having destinations within walking distance can encourage older people to walk. Yet, not all destinations may be equally important. Little is known about the types of destinations fostering older adults’ walking for transport in small and medium-sized towns and rural communities. The aim of this study was to explore the associations between the availability of different destinations and walking for transport among older adults living in communities with less than 100,000 inhabitants.

Methods

Between May and September 2019, self-reported data from 2242 older adults (≥ 65 years) living in the Metropolitan Region Northwest (Germany) were collected within the project AFOOT – Securing urban mobility of an aging population. Data from 2137 study participants were eligible for this analysis. Logistic regression models were used to investigate the relationship between the perceived destination availability of 19 different destinations within a 20-min or 10-min walk from home, respectively, and the engagement in walking for transport. Crude and adjusted models were run separately for each destination and distance category. Exploratory subgroup analyses examined the associations between the availability of destinations within a 20-min walk from home and walking for transport stratified by gender, use of a walking aid, and car availability.

Results

The availability of each of the investigated destinations within a 20-min walk and of nearly all of these destinations within a 10-min walk from home was significantly positively associated with walking for transport in crude models. Most associations remained significant after adjustment for covariates. The strongest associations were found for the availability of small stores, pharmacy, and bakery. The availability of a bus stop showed the weakest associations and was not significantly associated with walking for transport after adjustment for covariates.

Conclusions

The provision of local amenities within walking distance may be a promising approach to foster older adults’ walking for transport in smaller communities with less than 100,000 inhabitants and to enable active and healthy aging in place. Further quantitative and qualitative research is needed to validate these findings and to better understand older adults’ walking behavior.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02896-w.

Older Public Housing Tenants' Capabilities for Physical Activity Described Using Walk-Along Interviews in Montreal, Canada

Older public housing tenants experience various factors associated with physical inactivity and are locally dependent on their environment to support their physical activity. A better understanding of the person-environment fit for physical activity could highlight avenues to improve access to physical activity for this subgroup of the population. The aim of this study was to evaluate older public housing tenants' capabilities for physical activity in their residential environment using a socioecological approach. We conducted individual semi-structured walk-along interviews with 26 tenants (female = 18, male = 8, mean age = 71.96 years old). Living in housing developments exclusively for adults aged 60 years or over in three neighborhoods in the city of Montreal, Canada. A hybrid thematic analysis produced five capabilities for physical activity: Political, financial, social, physical, and psychological. Themes spanned across ecological levels including individual, public housing, community, and government. Tenant committees appear important to physical activity promotion. Participants called for psychosocial interventions to boost their capability for physical activity as well as greater implication from the housing authority and from government. Results further support a call for intersectoral action to improve access to physical activity for less affluent subgroups of the population such as older public housing tenants.

Nonlinear Associations of the Built Environment with Cycling Frequency among Older Adults in Zhongshan, China

The health and welfare of older adults have raised increasing attention due to global aging. Cycling is a physical activity and mode of transportation to enhance the mobility and quality of life among older adults. Nevertheless, the planning strategies to promote cycling among older adults are underutilized. Therefore, this paper describes the nonlinear associations of the built environment with cycling frequency among older adults. The data were collected from the Zhongshan Household Travel Survey (ZHTS) in 2012. The modeling approach was the eXtreme Gradient Boosting (XGBoost) model. The findings demonstrated that nonlinear relationships exist among all the selected built environment attributes. Within specific intervals, the population density, the land-use mixture, the distance from home to the nearest bus stop, and the distance from home to CBD are positively correlated to the cycling among older adults. Additionally, an inverse "U"-shaped relationship appears in the percentage of green space land use among all land uses. Moreover, the intersection density is inversely related to the cycling frequency among older adults. These findings provide nuanced and appropriate guidance for establishing age-friendly neighborhoods.

Social vulnerability associated with the self-reported diagnosis of type II diabetes: a multilevel analysis

OBJECTIVE

To analyze the contextual factors associated with type II diabetes mellitus in Belo Horizonte City.

METHODS

Cross-sectional study with 5,779 adults living in Belo Horizonte City, participating in the Risk and Protection Factors Surveillance System for Chronic Diseases through Telephone Survey (Vigitel), in 2008, 2009, and 2010. Multilevel regression models were used to test the association between contextual indicators of physical and social environments, and self-reported diagnosis of diabetes, adjusted for individual sociodemographic and lifestyle factors. Descriptive analyzes and multilevel logistic regression models were used, considering a 5% significance level.

RESULTS

The prevalence of diabetes was 6.2% (95%CI 5.54 - 6.92), and 3.1% of the variability of chance of presenting diabetes were explained by contextual characteristics. Living in areas with high density of private places for physical activity and high income was associated with a lower chance of having diabetes. The areas with high level of social vulnerability were strongly associated with the chance of presenting diabetes, adjusted for individual characteristics.

CONCLUSION

Characteristics of physical and social environments were associated with the chance of diabetes occurrence. Urban centers with opportunities to adopt healthy behaviors can help to reduce the occurrence of diabetes and its complications.

Barriers, Facilitating Factors, and Intersectoral Collaboration for Promoting Active Mobility for Healthy Aging-A Qualitative Study within Local Government in Germany

The promotion of walking and cycling to stay active and mobile offers great potential for healthy aging. Intersectoral collaboration for age-friendly urban planning is required in local government to realize this potential. Semi-structured interviews were conducted with the heads of planning and public health departments in city and district administrations of a Metropolitan Region in Germany to identify factors influencing action on the cross-cutting issue of active mobility for healthy aging. Although some administrations are working on the promotion of active mobility, they consider neither the needs of older people nor health effects. A lack of human resources and expertise, mainly due to the low priority placed on the issue, are described as the main barriers for further strategic collaboration. Furthermore, the public health sector often focuses on pathogens as the cause of morbidity and mortality, reducing their acceptance of responsibility for the topic. Facilitating factors include the establishment of new administrative structures, projects with rapid results that create awareness and credibility among citizens and politicians, additional staff with expertise in health promotion, and political commitment. In the future, new administrative structures for intersectoral collaboration are needed in order to consider various perspectives in complex developments, such as healthy aging, and to benefit from synergies.

Examining the association between perceived neighbourhood safety and health services utilization: A cross-sectional study among older adults in the United States of America

OBJECTIVE

To assess the association between perceived neighbourhood safety and health services use among older adults.

METHODS

The Health and Retirement Study was used to assess the association of perceived neighbourhood safety with inpatient hospital utilization, contact with a physician, home health use, and any health services utilization in the United States of America (n = 10,844). Logistic regression models were used, while controlling for a large number of potential confounders.

RESULTS

The odds of any contact with a physician were greater among those who perceived their neighbourhood safety to be excellent (odds ratio (OR): 1.81, 95% confidence interval (CI): 1.20, 2.72) or very good (OR: 1.56, 95% CI: 1.04, 2.32) compared with those who perceived their neighbourhood safety as fair or poor, controlling for all model covariates. The odds of any health services utilization were greater among those who perceived their neighbourhood safety to be excellent (OR: 1.95, 95% CI: 1.26, 3.00) or very good (OR: 1.63, 95% CI: 1.06, 2.50) compared with those who perceived their neighbourhood safety as fair or poor controlling for all other model covariates. The odds of inpatient care were higher among those who perceived their neighbourhood to be excellent compared with those who compared their neighbourhood to be fair/poor (OR: 1.22, 95% CI: 1.01, 1.48). Results were not statistically significant for home health utilization.

CONCLUSIONS

These analyses show a relationship between perceived neighbourhood safety and contact with a physician and any health services utilization among older adults and a weaker relationship between perceived neighbourhood safety and inpatient services. Future research should continue to examine this relationship between perceived neighbourhood safety and health services utilization among older adults.

Neighborhood walkability, physical activity and changes in glycemic markers in people with type 2 diabetes: The Hoorn Diabetes Care System cohort

Studies investigating neighborhood walkability and physical activity in people with type 2 diabetes (T2D) mainly used self-report measures, and only few studies assessed the association with glycemic control. This study assessed the associations between objectively measured (i.e. GIS based) and subjectively measured (i.e. questionnaire-based) neighborhood walkability and changes in glycemic markers in people with T2D, and whether this association was mediated by device-measured physical activity (PA), in the Diabetes Care System Cohort (n = 1230). Neither objective or subjectively measured walkability was associated with glycemic control. In mediation analyses we observed no overall mediation by PA.

The Associations of Built Environment with Older People Recreational Walking and Physical Activity in a Chinese Small-Scale City of Yiwu

Physical activity would bring in plenty of health benefits, especially recreational physical activity (RPA). Previous studies have suggested that built environment would affect older people's recreational walking (RW) and RPA, but how the effects exist in a small-scale Chinese city remains unclear. Two hundred and fifty-two older participants were recruited in the city of Yiwu using cross-sectional survey of random samples in 2019. RW and RPA level of participants and perceived scores of built environments were collected using the International Physical Activity Questionnaire and Neighborhood Environment Walkability Scale, respectively. Linear regression analysis was conducted to investigate the association of built environment with older people's RW and RPA. The results showed that two main factors affecting older people's RW and RPA were residential density and aesthetics. Additionally, access to services was related to RW, and street connectivity was correlated with RPA. The associations of RW with built environment varied slightly with demographic variables included in the regression model. All the results suggested that lower residential density, better aesthetics environment, and higher street connectivity would motivate older people to engage more in RW and RPA. The better access to services encourages only RW, not RPA, in older people. These findings would be helpful for policy decision makers in the urban construction process in Yiwu. More studies are needed to enlarge the scientific evidence base about small-scale cities in China.

Psychosocial and Social Environmental Factors as Moderators in the Relation between the Objective Environment and Older Adults' Active Transport

In order to develop tailored interventions aiming to encourage active transport among older adults, it is important to gain insights into the modifiable moderators affecting active transport behavior considering the neighborhood in which one lives. Therefore, this study aimed to determine which objective physical environmental factors have an impact on the active transport behavior of Belgian older adults (≥65 years old) and which psychosocial and social environmental moderators influence those relationships. Data from 503 independent living older adults who participated the Belgian Environmental Physical Activity Study in Seniors were included. Multilevel negative binominal regression models (participants nested in neighborhoods) with log link function were fitted for the analyses. Our resulted indicated that older adults living in an environment with higher residential density, higher park density, lower public transport density, and more entropy index had higher active transport levels. Furthermore, different types of neighborhood in which older adults live can lead to different moderators that are decisive for increasing older adults’ active transport behavior. Therefore, based on our results some recommendations towards tailored interventions could be given to increase older adults’ active transport behavior depending on the environment in which one lives.

Objective environmental exposures correlate differently with recreational and transportation walking: A cross-sectional national study in the Netherlands

Background Walking is a good and simple way to increase people's energy expenditure, but there is limited evidence whether the neighborhood environment correlates differently with recreational and transportation walking. AimTo investigate how recreational walking and transportation walking are associated with the natural and built environmental characteristics of the living environment in the Netherlands, and examine the differences in their associations between weekdays and weekends. Method and data We extracted the total duration of daily walking (in minutes per person) for recreation and transportation of adults aged 18 years and above from the Dutch National Travel Survey 2015-2017 (N = 65,785) and analyzed it as an outcome variable. Objective measures of the natural (i.e., normalized difference vegetation index (NDVI), blue space and meteorological conditions) and built environment (i.e., crossing density, land-use mix, and residential building density) around respondents' home addresses were determined for buffers with 300, 600, and 1000 m radii using a geographic information system. To assess associations between recreational and transportation walking and the environmental exposures separately, we fitted Tobit regression models to the walking data, adjusted for multiple confounders. ResultsOn weekdays, people living in areas with less NDVI, higher land-use mix, and higher crossing density were more likely to engage in transportation walking. Recreational walking was negatively associated with NDVI, blue space, crossing density, precipitation and daily average temperature. At weekends, land-use mix supports both recreational and transportation walking. A negative association appeared for NDVI and transportation walking. Daily average rainfall and temperature were inversely correlated with recreational walking. Sensitivity tests indicated that some associations depend on the buffer size. ConclusionsOur findings suggest that the built and natural environments are differently associated with people's recreational and transportation walking. We also found differences in the walking-environment associations between weekdays and weekends. Place-based policies to design walking-friendly neighborhoods may have different implications for different types of walking.

The Effect of the Built Environment on Older Men's and Women's Leisure-Time Physical Activity in the Mid-Scale City of Jinhua, China

Physical activity has been suggested to be beneficial in preventing disease and improving body function in older people. Older people's leisure-time physical activity (LTPA) is affected by various factors, especially environmental factors. However, the differences in the association between older people's LTPA and the built environment in different sex groups remain unclear. Perceived built environment scores and older people's LTPA were collected for 240 older people in Jinhua using the Neighborhood Environment Walkability Scale and International Physical Activity Questionnaire, respectively. A linear regression method was used to analyze the associations between older people's LTPA and the built environment in men, women, and all participants. The results showed that land use mix diversity was associated with LTPA in older people for both sexes. In men, LTPA was also associated with access to services. However, in women, LTPA was associated with residential density, street connectivity, and crime safety. The relationship varied when demographic variables were incorporated into the regression analysis. Those results indicated that a shorter perceived distance from home to destination would motivate older people to engage more in LTPA. Older people's LTPA was affected by various built environment factors according to different sex groups. Women's LTPA was generally more sensitive to the built environment. More studies are needed to confirm the association between LTPA in older people and the built environment in men and women in mid- or small-sized Chinese cities in the future.

Everyday Walking Among Older Adults and the Neighborhood Built Environment: A Comparison Between Two Cities in North America

A walkable neighborhood becomes particularly important for older adults for whom physical activity and active transportation are critical for healthy aging-in-place. For many older adults, regular walking takes place in the neighborhood and is the primary mode of mobility. This study took place in eight neighborhoods in Metro Portland (USA) and Metro Vancouver (Canada), examining older adults' walking behavior and neighborhood built environmental features. Older adults reported walking for recreation and transport in a cross-sectional telephone survey. Information on physical activity was combined with audits of 355 street segments using the Senior Walking Environmental Audit Tool-Revised (SWEAT-R). Multi-level regression models examined the relationship between built environmental characteristics and walking for transport or recreation. Older adults [N = 434, mean age: 71.6 (SD = 8.1)] walked more for transport in high-density neighborhoods and in Metro Vancouver compared to Metro Portland (M = 12.8 vs. M = 2.2 min/day; p < 0.001). No relationship was found between population density and walking for recreation. Older adults spent more time walking for transport if pedestrian crossing were present (p = 0.037) and if parks or outdoor fitness amenities were available (p = 0.022). The immediate neighborhood built environment supports walking for transport in older adults. Comparing two similar metropolitan areas highlighted that high population density is necessary, yet not a sufficient condition for walking in the neighborhood.

Walking for Transport among Older Adults: A Cross-Sectional Study on the Role of the Built Environment in Less Densely Populated Areas in Northern Germany

In the last decades, there has been rising interest in public health research in the importance of the built environment for a healthy and active life in old age, but little attention has been paid to less densely populated areas. This study aimed to explore the impact of the built environment on walking for transport in the context of an older population living in communities of <100,000 inhabitants. Within the project AFOOT–Securing urban mobility of an aging population, a cross-sectional postal survey was carried out from May to September 2019 in older adults (≥65 years) in the Metropolitan Region Northwest, Germany. Self-reported data from 2189 study participants were analyzed. Logistic and linear regression models were used to examine the associations between the built environment and walking for transport. Any walking and frequent walking were positively associated with nearly all built environment attributes, even after adjustment for demographic and health covariates. The amount of walking in minutes per week was associated only with residential density. Moderating effects of gender, age, and use of walking aids were identified. Improving the built environment appears to be a promising opportunity to motivate and enable older adults to walk for transport.

Comparison Study of Perceived Neighborhood-Built Environment and Elderly Leisure-Time Physical Activity between Hangzhou and Wenzhou, China

Physical activity and health are of significant importance for the rapid aging population in China. Built environment has been suggested to be associated with elderly physical activity and health. However, the association differences between cities remain unclear. Perceived built environment scores and elderly leisure-time physical activity (LTPA) of 308 elderly in Hangzhou and 304 elderly in Wenzhou were collected using Neighborhood Environment Walkability Scale and International Physical Activity Questionnaire, respectively. A multivariate linear regression method and T-test were used to analyze of the associations between elderly LTPA and built environment and the differences between the two cities, respectively. The results showed that LTPA was positively associated with walking/cycling facilities and crime safety in both cities. LTPA was positively correlated with residential density, aesthetics, pedestrian/traffic safety in Wenzhou and negatively correlated with access to services in Hangzhou. The perceived scores of aesthetics (2.71 vs. 2.45) and pedestrian/traffic safety (2.11 vs. 1.71) in Hangzhou were significantly higher than those in Wenzhou. The results suggested that built environment elements like higher walking/cycling facilities and crime safety may motivate elderly engaging LTPA in both cities. However, LTPA was affected by different factors in these two cities. In the urban redevelopment, survey conducted in its own city would provide meaningful information and cannot be neglected.

Neighborhood Resources Associated With Active Travel in Older Adults-A Cohort Study in Six European Countries

OBJECTIVES

To study associations between perceived neighborhood resources and time spent by older adults in active travel.

METHODS

Respondents in six European countries, aged 65-85 years, reported on the perceived presence of neighborhood resources (parks, places to sit, public transportation, and facilities) with response options "a lot," "some," and "not at all." Daily active travel time (total minutes of transport-related walking and cycling) was self-reported at the baseline (n = 2,695) and 12-18 months later (n = 2,189).

RESULTS

Reporting a lot of any of the separate resources (range B's = 0.19-0.29) and some or a lot for all four resources (B = 0.22, 95% confidence interval [0.09, 0.35]) was associated with longer active travel time than reporting none or fewer resources. Associations remained over the follow-up, but the changes in travel time were similar, regardless of the neighborhood resources.

DISCUSSION

Perceiving multiple neighborhood resources may support older adults' active travel. Potential interventions, for example, the provision of new resources or increasing awareness of existing resources, require further study.

Moving to policy-amenable options for built environment research: The role of micro-scale neighborhood environment in promoting walking

BACKGROUND

Altering micro-scale features of neighborhoods (e.g., the presence and condition of benches, sidewalks, trees, crossing signals, walking paths) could be a relatively cost-effective method of creating environments that are conducive to physical activity. The Virtual Systematic Tool for Evaluating Pedestrian Streetscapes (Virtual-STEPS) was created to virtually audit the microscale environment of cities using Google Street View (GSV). The objective of this study was to evaluate the collective influence of items from the Virtual-STEPS tool on walking outcomes (utilitarian walking and walking for leisure), while accounting for self-selection of walkers into walking-friendly neighborhoods.

METHODS

Adults (N = 1403) were recruited from Montreal and Toronto from neighborhoods stratified by their level of macro-scale walking-friendliness and walking rates. The micro-scale environment of 5% of street segments from the selected neighborhoods was audited using the Virtual-STEPS tool and a micro-scale environment score was assigned. The scores were then linked to each respondent from the survey. A multilevel logistic regression analysis was used to model the relationship between the micro-scale environment score and odds of both utilitarian walking (i.e., walking for purpose such as to go shopping or go to work or school) and walking for leisure for at least 150 min per week, while accounting for environmental and demographic covariates as well as self-selection.

RESULTS

Micro-scale neighborhood features were associated with elevated odds of walking for leisure (OR: 1.14, CI: 1.04-1.25). The association between micro-scale neighborhood features and walking for utilitarian purposes was, however, inconclusive (OR: 1.01, CI: 0.90-1.13). On the other hand, macro-scale walk-friendliness was associated with elevated odds of walking for utilitarian purposes (OR: 2.01, CI:1.42-2.84) and the association between macro-scale features and leisure walking was inconclusive (OR: 1.02, CI: 0.78-1.34).

CONCLUSIONS

Our results imply that micro-scale features of neighborhoods collectively promote leisure walking but not necessarily utilitarian walking, even after accounting for self-selection. In contrast, macro-scale features may collectively promote utilitarian walking, but not leisure walking. Micro scale features of neighborhoods fall within the budget of local jurisdictions and our results suggest that jurisdictions that improve micro-scale features may expect increased leisure walking in populations.

Perceived neighbourhood safety and volunteerism among older adults

Previous research shows the benefits of volunteerism to individuals and communities. The purpose of this study was to determine whether lower perceived neighbourhood safety is associated with reduced volunteerism and whether this association differs by sex. Data from the 2008 Health and Retirement Study in the United States of America were used (N = 13,009 adults 60 years and older). Multivariate logistic regression models were estimated to assess the association between perceived neighbourhood safety and volunteerism while controlling for potential confounders. Perceived neighbourhood safety was associated with volunteering. The odds of volunteering were higher for those rating their perceived neighbourhood safety as excellent compared with those rating their perceived neighbourhood safety as fair/poor. Those rating their perceived neighbourhood safety as very good also had greater odds of volunteering than those rating their perceived neighbourhood safety as fair/poor. Results differed somewhat by gender. Men who perceived their neighbourhood safety as excellent had increased odds of volunteering. The association of neighbourhood safety with volunteerism was significant for women rating their perceived neighbourhood safety as excellent or very good. Among men, being married was associated with increased odds of volunteering; being completely or partly retired was associated with increased odds of volunteering among women. Initiatives aimed at improving older adults’ perceptions of safety would help improve volunteerism, which is beneficial to both older adults and communities.

Associations Between Social and Physical Environments and Older Adults' Walking for Transportation and Recreation

This study examined the associations between physical environment, social environment, and walking for transportation and recreation among older adults in Hong Kong. Cross-sectional data from 450 older adults (79 years or younger [71.9%], female [79.7%]) from 18 districts in Hong Kong were used. The participants' perceptions of their physical and social environments were collected and their walking behaviors were self-reported. The results revealed that positive physical environment-facilitators and social environments were associated with increased total walking. Only positive physical environment-facilitators were associated with increased walking for transportation, and physical and social environments had no notable effect on walking for recreation. These findings suggest that policymakers and walking intervention designers should develop strategies to enhance physical and social environments to promote total walking and walking for transportation.

Barriers and Motivators of Bicycling by Gender Among Older Adult Bicyclists in the Midwest

Introduction. Physical activity (PA), particularly low-impact activities like bicycling, can improve health in older adults. However, bicycling rates are lower in the Midwest than other regions in the United States. Therefore, it is important to identify unique social, personal, and environmental factors that inhibit or promote bicycling, and how these are associated with PA. The influences of these factors were explored using the social ecological model. Method. A cross-sectional online survey was developed using previously validated local and national bicycling questionnaires, then distributed to Midwestern bicyclists 50 years and older. Exploratory factor analysis was conducted to understand the influences of social, personal, and environmental barriers and promoters on bicycling patterns. All models were conducted separately by gender, and accounted for age, race, education, marital status, income, and employment. Results. Social promoters (B = 0.386, p = .002), such as having friends/family that bicycle were associated with greater PA. Personal promoters (B = -0.311, p = .006) such as needing to lose weight were associated with reduced PA. Environmental factors had no associations with PA. However, individual environmental components, such as number of vehicles on the roads, were significantly associated with PA for both males and females. Females reported more barriers than males. The overall model accounted for 16.1% of the total variance in PA levels. Conclusion. Interventions to promote PA via bicycling in older adults should focus on social factors, while also reducing personal-level factors for males. Interventions for females could focus on reducing specific personal, social, and environmental barriers.

Caractéristiques environnementales favorisant la participation sociale: une enquête auprès d'aînés québécois

We document and compare the environmental characteristics potentially associated with social participation of older Quebecers, according to the level of rurality. A survey was carried out among older Quebecers aged 65 and over recruited by different senior groups and through social media. The Questionnaire their potential for social participation, developed from a systematic literature review, was completed by respondents. According to the 515 older participants, 71.5 years old on average, environmental characteristics linked to social participation, as well as user-friendliness of the city and neighborhood, are more favorably perceived in metropolitan and urban areas than rural areas. However, access to public transportation and the welcoming and openness of local residents are more appreciated by rural respondents. These results support the presence of inequalities in social participation according to level of rurality and offer some leads for action.

Public toilets in parklands or open spaces in international cities using geographic information systems

INTRODUCTION AND HYPOTHESIS

Availability of public toilets in parklands and open spaces is a community resource for all persons and may support self-management of incontinence. The purpose of this study was to describe and map the availability of public toilets in parklands and open spaces in major international cities by city population and area.

METHODS

Observational/descriptive design. Twelve cities in nine countries with available data about toilets in parklands (Minneapolis-St. Paul (MSP), New York City, Philadelphia, Toronto, and Osaka) or open spaces (Greater London, Greater Sydney, Paris, Berlin, Brussels, and Seoul) were included in the analysis. Data were from online open/free data sets. Availability of publicly owned and/or operated permanent toilet facilities was measured/analyzed as number, density (calculated by population and area (km²)), and distribution (visualized using Geographic Information Systems).

RESULTS

Density of public toilets/area (km²) in parklands was highest in Osaka. MSP had the most toilets per 100,000 residents. In open spaces, the density of public toilets/area (km²) was highest in Paris. Sydney had the most toilets in open spaces per 100,000 residents. The distribution of public toilets across parklands was fairly even in MSP, Philadelphia, and Toronto. The distribution of public toilets in open spaces was highly concentrated in one area in Brussels. Sydney has a low population density but a high toilet density in open spaces.

CONCLUSIONS

Availability of public toilets in parklands or open spaces varies among international cities. Toilet availability should be considered in urban planning and community healthcare programs to promote continence, health, and quality of life.

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

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

Perception of parks and trails as mobility facilitators and transportation walking in older adults: a study using digital geographical maps

BACKGROUND

Transportation walking represents a promising target for physical activity promotion in older adults. Perceived characteristics of the neighbourhood physical environment may affect older adults' choice of transportation mode for a routine activity such as walking to the grocery store.

AIMS

To (1) evaluate associations between older adults' perception of parks and trails as outdoor mobility facilitators and transportation walking, specifically to the grocery store; and (2) explore whether the spatial relationship between people's home, perceived facilitator and store was relevant for their transportation choice.

METHODS

Cross-sectional data were collected in a subsample of the 'Life-space mobility in old age' cohort. Multivariable logistic regression analysis on the binary outcome 'transportation walking' (vs. 'motorized transportation') was used to evaluate the association with perceived mobility facilitators in the neighborhood; in step (1) without and in step (2) with taking spatial relationships into account.

RESULTS

Perceiving a park as facilitator increased the odds of walking (N = 179; Odds Ratio 9.89; 95% Confidence interval 3.11-31.50). Spatial relationships did not affect transportation choice. Reporting a trail as facilitator was not significantly associated with walking.

CONCLUSIONS

Our findings suggest that the perception of environmental characteristics in the neighbourhood has an influence on older people's transportation choices. Taking environmental measures or informing older adults on their options in the neighbourhood might be possible ways to increase older adults' transportation walking on a population level.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO 2016:CRD42016051180.

Mobility performance among community-dwelling older Filipinos who lived in urban and rural settings: A preliminary study

Background:

The impact of residential setting on the performance of older adults on commonly used instruments of mobility has not been closely investigated.

Objective:

This study aimed to (1) explore whether mobility test performance differed between those who lived in urban and rural communities, and (2) report preliminary reference values for these tests according to residential setting.

Methods:

The study used a descriptive design. Individuals who were aged 60 years and above, had no significant disability, and resided in urban and rural areas in the Philippines (n=180), participated in the study. Researchers measured mobility performance using the 10-Meter Walk Test (10MWT) (both comfortable gait velocity (CGV) and fast gait velocity (FGV)), Five Times Sit to Stand Test (FTSST), and Six-Minute Walk Test (6MWT). Preliminary reference values for the mobility tests were presented as means, standard deviations, and 95% confidence intervals. Scores were compared based on residential setting (urban versus rural).

Results:

Urban-dwellers scored consistently better compared to their rural counterparts on the CGV, FGV, FTSST, and 6MWT using independent samples t-test (p<0.001). Data were further divided according to age and sex, and comparison of the mobility test scores between urban- and rural-dwellers within each subgroup showed similar differences (p<0.01).

Conclusion:

Results provide preliminary evidence for the influence of residential setting on the mobility test performance of Filipino older adults. The study provides a good starting point for confirmatory research with a representative sample to (1) illustrate differences in mobility performance according to residential setting, (2) investigate how specific factors associated with residential settings contribute to differences in mobility performance, and (3) determine the extent to which clinicians should consider an older person’s residential setting when interpreting mobility test results.

Individual, social, and physical environmental factors related to changes in walking and cycling for transport among older adults: A longitudinal study

To date, no longitudinal studies examined the change in walking and cycling for transport as distinct outcomes over time and investigated the predictors of those changes. Therefore, this present study examined the change in odds of engagement in walking and cycling for transport as distinct outcomes among Belgian older adults over a three-year follow-up period, and examined factors (i.e. socio-demographics, psychosocial, perceived social and physical environmental characteristics) related to these changes in engaging in walking and cycling for transport. Against our expectations, we found significantly higher odds of engaging in cycling for transport among older adults at follow-up compared to baseline and no significant differences in the odds of engaging in walking for transport. Interventions should assist older adults to increase their self-efficacy towards PA, their perceived benefits of PA, and their perception of land use mix diversity in their neighborhood in order to increase the engagement in walking/cycling for transport over time, or help to decrease their perceived barriers towards PA or their perception to have a lot of physical barriers to walk/cycle in their neighborhood. Future longitudinal studies with larger samples are warranted investigating interaction effects between different predictors at various levels to find out which factors can be further integrated into active transport interventions in older adults.

Are Neighborhood Environmental Attributes More Important for Older Than for Younger Adults' Walking? Testing Effect Modification by Age

Older adults are often considered more vulnerable to environmental factors than are younger adults. We examined whether the associations of objectively measured environmental attributes (Walk Score; street connectivity) with walking for transport differed between younger- (25-44 years), middle- (45-64 years), and older-aged (65-84 years) adults, using a large Australian sample of 14,656 people. Walk Score and street connectivity were similarly associated with walking (any; 30+ min/day) in all age groups. Contrary to commonly held views, the study did not find any evidence suggesting that older adults may be more sensitive to their environment to get out and walk than are younger adults, at least for the environmental attributes examined in this study. Further research is needed to investigate if there are particular environmental factors that hinder older adults from being active.

Neighborhood environmental factors are related to health-enhancing physical activity and walking among community dwelling older adults in Nigeria

Introduction: Health promotion strategies grounded by evidence-based determinants of physical activity constitute an important focus of physiotherapy practice in the twenty-first century. This study investigated associations between neighborhood environmental factors and health-related moderate-to-vigorous physical activity (MVPA) and walking for transportation and recreation among community dwelling Nigerian older adults. Methods: A representative sample of 353 Nigerian older adults (age = 68.9 ± 9.13 years) in a cross-sectional survey provided self-reported min/week of MVPA and walking for transportation and recreation and perceived neighborhood environmental factors. Results: In multilevel linear regression analyses, proximity of destinations (β = 3.291; CI = 0.392, 6.191), access to services and places (β = 4.417; CI = 0.995, 7.838), esthetics (β = 3.603; CI = 0.617, 6.590), traffic safety (β = 5.685; CI = 3.334, 8.036), and safety from crime (β = 1.717; CI = 0.466, 2.968) were related to more MVPA. Also, proximity of destinations (β = 1.656; CI = 0.022, 3.291) and safety from crime (β = 2.205; CI = 0.018, 4.579) were related to more transport walking. Access to services and places (β = 2.086; CI = 0.713, 3.459) and walking infrastructure and safety (β = 1.741; CI = 0.199, 3.282) were related to more recreational walking. Conclusions: Six of eight supportive environmental factors were associated with more physical activity among community dwelling older Nigerian adults. Policy makers including physiotherapists in this role can use the evidence to inform community-based physical activity and health promotion programs for older adults in Nigeria.

Helpfulness, Trust, and Safety of Neighborhoods: Social Capital, Household Income, and Self-Reported Health of Older Adults

Background and Objectives

Growing literature documents that where you live has an impact on your health, due in part to social capital. Building on social capital literature, we assess how subjective appraisals of neighborhood quality are associated with self-reported health (SRH) for older adults.

Research Design and Methods

Cross-sectional analysis of the 2014 California Health Interview Survey, a representative survey of diverse, noninstitutionalized California residents. We use three measures of neighborhood quality: trustworthy neighbors, helpful neighbors, and feeling safe. Using weighted ordinary least squares regression, we assess the associations of trust, helpfulness, and safety to SRH, controlling for neighborhood, demographic, and health care variables. We then examine how these associations vary by household income.

Results

We find that characterizing neighbors as helpful and feeling safe are associated with better SRH, even controlling for community, demographic, and health care variables. However, the importance of these dimensions varies across household income: helpfulness is positively associated, whereas trust is negatively associated with SRH for lower income residents; safety is positively associated with SRH in all but the lowest income residents. These findings show that social capital dimensions work differently from one another, and differentially affect the health of older adults.

Discussion and Implications

Scholarly analyses of neighborhood effects should include a range of social capital measures and stratify by household income. Our findings may also inform priority setting for social capital programs, especially for older adults with limited economic resources. Policies and programs should consider actions that raise perceptions of helpfulness and safety.

Associations of Older Taiwanese Adults' Personal Attributes and Perceptions of the Neighborhood Environment Concerning Walking for Recreation and Transportation

This study examines the cross-sectional associations between personal and perceived neighborhood environment attributes regarding walking for recreation and transportation among older Taiwanese adults. Data related to personal factors, perceived environmental factors, and time spent engaging in transportation-related and recreational walking were obtained from 1032 older adults aged 65 years and above. The data were analyzed by carrying out an adjusted binary logistic regression. After adjusting for potential confounders, two commonly perceived environmental factors, the presence of sidewalks (PS) and the presence of a destination (PD), were positively associated with 150 min of walking for recreation. Different personal and perceived environmental factors were associated with walking for recreation and transportation. These findings suggest that policy-makers and physical activity intervention designers should develop both common and individual environmental strategies in order to improve and increase awareness of the neighborhood environment to promote recreational and transportation walking behaviors among older adults.

Perceived urban neighborhood environment for physical activity of older adults in Seoul, Korea: A multimethod qualitative study

This study assessed the attributes of a perceived urban neighborhood environment for the physical activity (PA) of older adults by applying a qualitative multimethod approach to collect both descriptive and spatial information. Conducted in a northern community of Seoul, Korea, from April 2014 to November 2015, data collection methods included 90 walking tours by researchers, 46 face-to-face, semi-structured interviews combined with qualitative mapping with senior residents aged 65+, 19 guided tours with the interviewees, and 3 focus groups with 12 community service providers. Thematic analysis and pattern finding were performed on the data. Walking was the main type of PA of the older adults. Nine attributes of perceived neighborhood environment for PA were identified under three themes: daily living (everyday life activities, mobility, social opportunities, diverse destinations); the multidimensionality of accessibility (physical, economic, psychosocial), and attractiveness and pleasantness (maintenance, aesthetics). The subcategories of the attributes included proximity, access to public transportation, walkability, cost-worthiness, low or no cost, familiarity, sense of welcoming, sociocultural appropriateness, fair access, order and upkeep, safety, openness, cleanliness, and interestingness. Strategies to generate more movement and activities in the everyday routine of the elderly should be a core task for health promotion and neighborhood design. A strategic application of multiple qualitative methods can create an opportunity to build contextual understanding and to generate ideas in interactions with the community.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The role of the built environment in a randomized controlled trial to increase physical activity among men with prostate cancer: the PROMOTE trial

PURPOSE

The purpose of the study was to examine the association between the built environment and physical activity (PA) in prostate cancer survivors (PCS), as well as whether built environment factors (walkability, count of sports complexes) were effect modifiers of a PA intervention.

METHODS

Our study included 165 PCS residing in Edmonton, Alberta, from the PROMOTE trial. The PROMOTE trial was a randomized controlled trial of a behaviour change intervention to increase PA and quality of life in PCS. In the PROMOTE trial, 423 PCS were randomly assigned to a standard physical activity recommendation, self-administered implementation intention, or telephone-assisted implementation intention group. PA and quality of life outcomes were assessed at baseline, 1, and 3 months. To explore the role of the built environment, this study examined walkability and count of sport complexes.

RESULTS

Linear regression analyses revealed that the self-administered intervention group had an increase in self-reported PA minutes/week (β = 133.4, 95% CI = -18.9 to 285.6); however, none of the built environment variables were found to be significantly associated with PA. The logistic regression showed that the self-administered intervention group had a significantly greater likelihood of meeting the PA guidelines (OR = 2.1, 95% CI = 0.9 to 4.9), though no built environment variables were associated with PA levels.

CONCLUSIONS

Our findings suggest that the built environment was not associated with PA and was not an effect modifier in a PA behaviour change intervention for PCS. Further research is needed before clear conclusions can be generated ( ClinicalTrials.gov number NCT01410656).