The Associations Between Access to Recreational Facilities and Adherence to the American Heart Association's Physical Activity Guidelines in US Adults

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Physical Activity, Cardiorespiratory Fitness, and the Obesity Paradox with Consideration for Racial and/or Ethnic Differences: A Broad Review and Call to Action

Despite decades of extensive research and clinical insights on the increased risk of all-cause and disease-specific morbidity and mortality due to obesity, the obesity paradox still presents a unique perspective, i.e., having a higher body mass index (BMI) offers a protective effect on adverse health outcomes, particularly in people with known cardiovascular disease (CVD). This protective effect may be due to modifiable factors that influence body weight status and health, including physical activity (PA) and cardiorespiratory fitness (CRF), as well as non-modifiable factors, such as race and/or ethnicity. This article briefly reviews the current knowledge surrounding the obesity paradox, its relationship with PA and CRF, and compelling considerations for race and/or ethnicity concerning the obesity paradox. As such, this review provides recommendations and a call to action for future precision medicine to consider modifiable and non-modifiable factors when preventing and/or treating obesity.

Social deprivation and diabetic kidney disease: A European view

There is a large body of literature demonstrating a social gradient in health and increasing evidence of an association between social deprivation and diabetes complications. Diabetic kidney disease (DKD) increases mortality in people with diabetes. Socioeconomic deprivation is increasingly recognized as a modifier of risk factors for kidney disease but also an independent risk factor itself for kidney disease. This may not be truly appreciated by clinicians and warrants further attention and exploration. In this review we explore the literature to date from Europe on the relationship between social deprivation and DKD. The majority of the studies showed at least an association with microalbuminuria, an early marker of DKD, while many showed an association with overt nephropathy. This was seen across many countries in Europe using a variety of different measures of deprivation. We reviewed and considered the mechanisms by which deprivation may lead to DKD. Health related behaviors such as smoking and suboptimal control of risk factors such as hypertension, hyperglycemia and elevated body mass index (BMI) accounts for some but not all of the association. Poorer access to healthcare, health literacy, and stress are also discussed as potential mediators of the association. Addressing deprivation is difficult but starting points include targeted interventions for people living in deprived circumstances, equitable roll out of diabetes technology, and flexible outpatient clinic arrangements including virtual and community-based care.