Neighbourhood Built Environment Influences on Physical Activity among Adults: A Systematized Review of Qualitative Evidence

Using the Age-Friendly Environment Framework to Assess Advance Care Planning Factors Among Older Adults With Limited Income: A Cross-Sectional, Descriptive Survey Study

BACKGROUND AND OBJECTIVES

The World Health Organization created the Age-Friendly Environment (AFE) framework to design communities that support healthy aging and equitable decision making. This framework's resource domains may account for disparately lower advance care planning (ACP) among older adults with limited incomes compared to those with high incomes. We aimed to describe and examine associations of AFE factors with ACP.

RESEARCH DESIGN AND METHODS

We recruited and conducted cross-sectional surveys among older adults with limited incomes in 7 community-based settings in Nashville, TN. ACP and AFE item scales were dichotomized and analyzed with unadjusted phi correlation coefficients.

RESULTS

Survey participants (N = 100) included 59 women, 70 Black/African American, and 70 ≥60 years old. Most participants agreed that their community was age friendly (≥58%) and varied in ACP participation (22%-67%). Participants who perceived easy travel and service access and sufficient social isolation outreach were more likely to have had family or doctor quality-of-life discussions (phi = 0.22-0.29, p < .05). Having a healthcare decision maker was positively associated with age-friendly travel, housing, and meet-up places (phi = 0.20-0.26, p < .05).

DISCUSSION AND IMPLICATIONS

The AFE framework is useful for exploring the environmental factors of ACP, but further research is warranted to identify specific and immediate resources to support successful ACP among populations with socioeconomic disadvantage.

Residential greenness and chronic obstructive pulmonary disease in a large cohort in southern China: Potential causal links, risk trajectories, and mediation pathways

INTRODUCTION

Residential greenness may influence COPD mortality, but the causal links, risk trajectories, and mediation pathways between them remain poorly understood.

OBJECTIVES

We aim to comprehensively identify the potential causal links, characterize the dynamic progression of hospitalization or posthospital risk, and quantify mediation effects between greenness and COPD.

METHODS

This study was conducted using a community-based cohort enrolling individuals aged ≥ 18 years in southern China from January 1, 2009 to December 31, 2015. Greenness was characterized by normalized difference vegetation index (NDVI) around participants' residential addresses. We applied doubly robust Cox proportional hazards model, multi-state model, and multiple mediation method, to investigate the potential causal links, risk trajectories among baseline, COPD hospitalization, first readmission due to COPD or COPD-related complications, and all-cause death, as well as the multiple mediation pathways (particulate matter [PM], temperature, body mass index [BMI] and physical activity) connecting greenness exposure to COPD mortality.

RESULTS

Our final analysis included 581,785 participants (52.52% female; average age: 48.36 [Standard Deviation (SD): 17.56]). Each interquartile range (IQR: 0.06) increase in NDVI was associated with a reduced COPD mortality risk, yielding a hazard ratio (HR) of 0.88 (95 % CI: 0.81, 0.96). Furthermore, we observed per IQR (0.04) increase in NDVI was inversely associated with the risk of multiple transitions (baseline - COPD hospitalization, baseline - death, and readmission - death risks), especially a declined risk of all-cause death after readmission (HR = 0.66 [95 %CI: 0.44, 0.99]). Within the observed association between greenness and COPD mortality, three mediators were identified, namely PM, temperature, and BMI (HR for the total indirect effect: 0.773 [95 % CI: 0.703, 0.851]), with PM showing the highest mediating effect.

CONCLUSIONS

Our findings revealed greenness may be a beneficial factor for COPD morbidity, prognosis, and mortality. This protective effect is primarily attributed to the reduction in PM concentration.

Health equity in urban and rural settings: implementation of the place standard tool in Spain

The physical, social, and economic characteristics of neighborhoods and municipalities determine the health of their residents, shaping their behaviors and choices regarding health and well-being. Addressing local environmental inequalities requires an intersectoral, participatory, and equity-focused approach. Community participation plays a vital role by providing deeper insights into local contexts, integrating community knowledge and values into processes, and promoting healthier, fairer, and more equitable actions. In recent years, various tools have been developed to assess places and transform them into health-promoting settings. One such tool, the Place Standard Tool (PST), facilitates discussions on Social Determinants of Health grouped into 14 themes, serving as a starting point for local health interventions. In this study, that took place between August 2019 and February 2020, we described the resident's perceptions of two municipalities in the Valencian Community, Spain, using the validated Spanish version of the PST. A mixed-method convergent-parallel design was used to gain a holistic insight into residents' experiences concerning their physical, economic, and social environment. A total of 356 individuals from both municipalities participated in the study through discussion groups, structured interviews, and online survey. Descriptive analysis of the individual questionnaire answers was conducted, and differences between municipalities were explored. Qualitative thematic analysis was conducted on structured interviews and discussion groups. Quantitative and qualitative data were integrated to facilitate their comparison and identify areas of convergence or divergence in the findings. Overall, rural areas received more favorable evaluations compared to urban ones. Public Transport as well as Work and Local Economy were consistently rated the lowest across all groups and contexts, while Identity and Belonging received the highest ratings. In the urban area, additional negative ratings were observed for Traffic and Parking, Housing and Community, and Care and Maintenance. Conversely, Identity and Belonging, Natural Spaces, Streets and Spaces, Social Interaction, and Services emerged as the highest-rated themes overall. In the rural context, positive evaluations were given to Walking or Cycling, Traffic and Parking, Housing and Community, and Influence and Sense of Control. Significant differences (p < 0.01) between urban and rural settings were observed in dimensions related to mobility, spaces, housing, social interaction, and identity and belonging. Our study illustrated the capacity of the PST to identifying aspects within local settings that influence health, revealing both positive and challenging factors. Successful implementation requires appropriate territorial delineation, support from local authorities, and effective management of expectations. Furthermore, the tool facilitated community participation in decision-making about local environments, promoting equity by connecting institutional processes with citizen needs.

Short-term health effects of an urban regeneration programme in deprived neighbourhoods of Barcelona

Urban regeneration programmes are interventions meant to enhance the wellbeing of residents in deprived areas, although empirical evidence reports mixed results. We evaluated the health impact of a participatory and neighbourhood-wide urban regeneration programme, Pla de Barris 2016-2020, in Barcelona. A pre-post with a comparison group study design. Using data from a cross-sectional survey performed in 2016 and 2021. The health outcomes analysed were mental health, alcohol and psychotropic drug use, perceived health status, physical activity and obesity. Depending on the investment, two intervention groups were defined: moderate- and high-intensity intervention groups. The analysis combined difference-in-difference estimation with an inverse weighting derived from a propensity score to reduce potential biases. The impact of the intervention in percentages and its confidence interval were estimated with a linear probability model with clustered adjusted errors. The intervention had a positive impact on health outcomes in women in the high-intensity intervention group: a reduction of 15.5% in the relative frequency of those experiencing poor mental health, and of 21.7% in the relative frequency of those with poor self-perceived health; and an increase of 13.7% in the relative frequency of those doing physical activity. No positive impact was observed for men, but an increase of 10.3% in the relative frequency of those using psychotropic drugs in the high-intensity intervention group. This study shows positive short-term effects of the urban regeneration programme Pla de Barris 2016-2020 on health outcomes in women in the high-intensity intervention group. These results can guide future interventions in other areas.

Similarities and differences in factors associated with high and low sedentary behavior after stroke: a mixed methods study

PURPOSE

To identify similarities and differences in factors affecting activity engagement between adults with stroke who are more and less sedentary.

MATERIALS AND METHODS

Data were pooled from two studies of adults with stroke (N = 36). Sedentary time was measured activPAL micro3. Participants completed activPAL interviews, which were analyzed using framework analysis. Participants were stratified into more and less sedentary groups based on activPAL data. Between-group similarities and differences were identified.

RESULTS

Adults with stroke (mean [SD] age = 65.8 [13.6] years, stroke chronicity = 40.5 [SD = 38.3] months, 36.1% female) were more sedentary (785.5 [64.7] sedentary minutes/day) and less sedentary (583.6 [87.4] sedentary minutes/day). Those who were more sedentary: engaged in basic activities of daily living, avoided activities, received assistance from other people, and did not use strategies to overcome barriers. Those who were less sedentary: engaged in instrumental and community activities, embraced new strategies, did activities with other people, and used strategies to overcome environmental barriers.

CONCLUSIONS

Factors affecting activity engagement differed between people who are more and less sedentary. Interventions that aim to reduce post-stroke sedentary behavior should consider the: (1) types of activities, (2) role of other people, and (2) application of strategies to overcome activity and environment-related barriers.

Subjective walkability perceived by children and adolescents living in urban environments: A study protocol for participatory methods and scale development in the WALKI-MUC project

BACKGROUND

Youth's perceptions of a city or neighbourhood's walkability are important for determining the physical activity (PA) friendliness of their environment. Traditional objective measures of walkability fail to incorporate children and youth's (CY) subjective perceptions of places that they perceive as supportive for play and exercise. Internationally, the most promising subjective measure is the Neighborhood Environment Walkability Scale for Youth (NEWS-Y) questionnaire. Yet, the NEWS-Y is not available for German-speaking adolescents. In the WALKI-MUC project, a combination of participatory research methods is used to identify CY's perceptions of PA-friendly places in Munich, Germany. Based on the findings, a German version of the NEWS-Y (NEWS-Y-G) for subjective walkability measurement is developed.

METHODS AND DESIGN

CY aged six to 17 years from neighbourhoods with different objectively-measured walkability, take part in photovoice, walking interviews and mapping to gather their perceptions of PA-friendly places. The participatory study begins with an introductory workshop and concludes with a follow-up workshop, where characteristics of PA-friendly places are discussed in focus groups. In between these workshops, participants complete a photo mission with a walking interview, allowing for individual significance of PA-related places to be shared in a one-on-one setting with the researcher. The findings are used to adapt and translate the NEWS-Y for the German context. The newly developed NEWS-Y-G is then used to measure the subjective walkability perceived by a representative sample of adolescents in Munich.

DISCUSSION

The WALKI-MUC project introduces a participatory methodology for researchers and urban planners to assess subjective walkability with CY. The combination of qualitative and quantitative walkability measurements is described in this study protocol. Findings on PA-friendly places contribute to environmental psychology and the development of the NEWS-Y-G adds a German-language instrument for subjective walkability measurement.

Assessing physical activity promotion in different settings and how its associated with public participation during COVID-19 epidemic: evidence from national policy evaluation

BACKGROUND

Various interventions, programs and policies have been implemented to improve physical activity (PA) levels worldwide. However, countries continue to face barriers and challenges in achieving their targets. To date, there is a lack of study on the evaluation of physical activity (PA) promotion and how it's associated with public participation.

METHODS

This study assessed PA promotion in eight different settings in terms of policy availability, policy implementation, and public participation in PA programs. Policy availability was assessed by reviewing 384 policy and strategy documents, rules, regulations, legislation, and guidelines on PA. We scored the documents by using the Comprehensive Analysis of Policy on Physical Activity (CAPPA) framework. Data to assess policy implementation and public participation were taken from the Thailand Report Card Survey 2021 (TRC2021), and the Thailand Surveillance on Physical Activity (SPA) 2021. Both surveys comprised over 5,000 nationally-representative samples from on-screen, face-to-face interviews, and an online self-administered survey. We scored the policy implementation and public participation based on respondents' response towards policy implementation and participation indicators. A grading scheme was applied to indicate how successful an investment has been made.

RESULTS

Public education and mass media received the highest average score in policy availability, implementation and public participation in PA program (67.9%, grade B), followed by active urban design (66.1%, grade B-) and active transport (63.7%, grade B-). Workplace, whole-of-school, and community-wide initiatives were the investments with the lowest scores, implying low availability, limited implementation, and less accessibility to public. Females were less likely to participate in active transport, active urban design, sports/recreation for all, workplace activity, and community-wide initiatives. Age and educational attainment were consistent predictors of utilization in all investments.

CONCLUSIONS

With varying degrees of policy availability and accessibility, public participation in PA investments is likely to be constrained by biological and socioeconomic inequality. Future investments should aim at providing generalized or tailored interventions to ensure equal access and participation for all segments of the population.

The relationship between tree canopy and social capital on physical activity in college students

OBJECTIVE

Rates of physical activity (PA) are low, especially among college students. Tree canopy and social capital have been correlated with higher rates of PA. This study assessed the relationship between tree canopy and social capital on minutes of PA.

PARTICIPANTS

Students from the University of Nevada, Las Vegas, located in Southern Nevada, were surveyed on social capital and self-reported minutes of PA.

METHODS

Tree canopy coverage was calculated within a 1 km walk buffer around each participant's home. Logistic regression was used to determine if tree canopy and social capital predicted meeting PA recommendations of 150 minutes/week.

RESULTS

42.4% of participants met the PA recommendations and males were more likely than females to meet them (odds ratio [OR] = 0.517). Social capital was a significant predictor of PA (OR = 1.308) while tree canopy was not.

CONCLUSIONS

Exploration of social capital to increase PA and further investigations into correlates of PA for college students in sprawling desert environments are recommended.

Explaining the lower usage rate of indigenous construction materials in Ghanaian public buildings using bounded rationality

Judicious use of Indigenous Construction Materials (ICM) contributes to sustainability of a local construction industry. Why has the use of ICMs not contributed to the sustainability of the Ghanaian Construction Industry (GCI), and how can the use of ICMs engender the sustainability of GCI and that of similar developing countries? This paper uses bounded rationality and mixed-method strategy to explain the ICM usage rate in the GCI, and describes measures for improving the sustainability of the local construction industry through ICMs use. Relatively high ICM cost and non-availability of alternatives have been found as factors largely responsible for constrained ICMs usage. This paper is one of the first to draw on a synergy of the bounded rationality theory and empirical findings to give advanced insight into factors constraining the use of ICMs, as well as provide a measured usage rate of local building materials using real building projects cases. The research has carved a path for nurturing sustainable construction industry in developing countries through indigenous resources.

Effects of built and natural environments on leisure physical activity in residential and workplace neighborhoods

Few studies have investigated relative contributions of the built and natural environments to and their nonlinear associations with leisure physical activity (PA) in different spatial contexts. Applying gradient boosting decision tree models to data comprising 1049 adults collected in Shanghai, we investigated the associations between built and natural environments and leisure PA in residential and workplace neighborhoods. Results show that the built environment is more important than the natural environment to leisure PA in both residences and workplaces. Environmental attributes have nonlinear and threshold effects. Within certain ranges, land use mix and population density have opposite associations with leisure PA in residences and workplaces, whereas the distance to the city center and the area of water are associated with leisure PA in residences and workplaces with the same direction. These findings help urban planners design context-specific environmental interventions for supporting leisure PA.

Making Chile More Pedestrian-Friendly for Older Persons: Expert Perspectives

Walking provides numerous benefits to older persons, but its practice is hindered by social factors and the built environment. This article aims to understand the factors that encourage or discourage older people's walking behaviors, as well as the policies influencing those factors in Chile. It does so by reporting the analysis of twenty-five semi-structured interviews with Chilean policymakers and local leaders. The experts consistently represented walking as a beneficial activity for older persons that, nonetheless, occurs in adverse built environments. They asserted that the absence of older people in the public discussion and a top-down policy-making structure hamper its promotion.

Recovery shape of physical activity after COVID-19 pandemic

BACKGROUND

Since the shutdowns associated with the coronavirus disease 2019 pandemic, there has been limited discourse on physical activity (PA) recovery (i.e., the ability of individuals to resume PA at pre-pandemic levels), including recovery rate, speed of recovery, which individuals are able to return quickly, who is left behind, and what are the causes of those differences. This study aimed to estimate the level and shape of PA recovery rate in Thailand.

METHODS

This study employed 2 rounds (2020 and 2021) of Thailand's Surveillance on Physical Activity dataset for the analysis. Each round included over 6600 samples from individuals aged 18 years or older. PA was assessed subjectively. Recovery rate was calculated from the relative difference in the cumulative minutes of MVPA from 2 different periods.

RESULTS

The Thai population experienced a medium level of recession of PA (-26.1%) and a moderate level of recovery of PA (37.44%). PA recovery in the Thai population resembled an imperfect V shape, reflecting a sharp decline followed by an immediate upturn; still, recovered PA remained lower than pre-pandemic levels. The quickest recovery was found among older adults, whereas students, young adults, residents of Bangkok, the unemployed, and those who had a negative attitude toward PA experienced the highest recession of PA and were among the slowest to recover.

CONCLUSION

The level of recovery of PA among Thai adults is largely determined by the preventive behaviors demonstrated by groups within the population who have a higher awareness of their health. The effect of the mandatory coronavirus disease 2019 containment measures on PA was temporary. However, the slower recovery rate of PA among some individuals was caused by a combination of restrictive measures and socioeconomic inequality, which required more time and effort to overcome.

Association of fast-food restaurants with overweight and obesity in school-aged children and adolescents: A systematic review and meta-analysis

We aimed to explore associations between the accessibility of fast-food restaurants (FFRs) and weight-related outcomes in children and adolescents through a systematic review and meta-analysis of studies. We searched three databases for studies published before October 21, 2022. Study quality was assessed using the National Institutes of Health's Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Meta-analysis was performed, and the leave-one-out method was used for sensitivity analysis. A total of 60 studies were included. According to our analysis, FFRs within a smaller buffer radius from residences or that provide unhealthy foods may have a more significant influence on children's and adolescents' weight. Children of younger ages and girls may have a higher possibility of being overweight due to FFRs. Though we could hardly avoid bias, the estimates in low-and middle-income countries (only six studies) are much higher than those in high-income countries (54 studies). More research analyses based on microscope data and individual economic levels are needed. This study yields quantitative results, provides policymakers and urban planners with a theoretical support for building resilient and sustainable human settlements, and promotes the translation of research findings from public health to environmental planning.

Placemaking and infrastructure through the lens of levelling up for health equity: A scoping review

The planning and delivery of infrastructure influences how places create health equity. The scholarship on place and health has recently been developed into 'levelling up' principles for equity focussed policy and planning. We conducted a scoping review of the literature on infrastructure through urban regeneration and placemaking interventions. We interrogated the 15 final selected articles for their use of one or more of the five 'levelling' up principles. No article encompassed all five principles. It was most common to find two or three principles in action. Reviewing the articles against the principles allows a deeper explanation of how infrastructure planning practice can positively impact on health equity. We conclude that applying all the principles in standard infrastructure planning practice has great potential for creating places that are positive for health equity.

Walk Score and Neighborhood Walkability: A Case Study of Daegu, South Korea

Walking is a popular physical activity that helps prevent obesity and cardiovascular diseases. The Walk Score, which measures neighborhood walkability, considers access to nine amenities using a geographic information system but does not deal with pedestrian perception. This study aims to (1) examine the correlation between access to each amenity, an individual component of the Walk Score, and perceived neighborhood walkability and (2) investigate the correlation with the perceived neighborhood walkability by adding variables of pedestrian perception to the existing Walk Score components. This study conducted a survey with 371 respondents in Daegu, South Korea, between 12 October and 8 November 2022. A multiple regression model was used to examine the correlations. The results showed no association between perceived neighborhood walkability and the individual component of the Walk Score. As variables of environmental perception, the fewer hills or stairs, the more alternative walking routes, the better separation between road and pedestrians, and the richer the green space, the more people perceived their neighborhood as walkable. This study found that the perception of the built environment had a more substantial influence on perceived neighborhood walkability than the accessibility to amenities. It proved that the Walk Score should include pedestrian perception and quantitative measurement.

Linking Urban Planning, Community Environment, and Physical Activity: A Socio-Ecological Approach

Lack of physical activity is a growing concern among public health advocates and urban planners. Our socio-ecological model incorporates urban planning and World Health Organization actions on physical activity to identify key factors related to leisure-time physical activity at the community level. Our 2019 nationwide US survey of 1312 communities enables examination of the influence of individual, community, and policy levels on physical activity. Individual factors-poverty, aging, minority population, and longer commuting time-result in lower physical activity. Community-level factors have both positive and negative effects. Physical activity is lower in rural and suburban communities, but higher in communities with more transportation services, recreation and social activities, and safety. Communities with mixed-use neighborhoods and complete streets also show higher levels of physical activity. At the policy level, zoning and cross-agency collaboration have an indirect effect on physical activity by increasing these community-level factors. This suggests an alternative approach to promoting physical activity. Local governments can promote transportation, recreation and safety, especially in rural and minority communities lacking active-friendly built environments and facing challenges from aging population, poverty, and longer commuting time. This socio-ecological approach can assess multilevel factors related to physical activity in other countries.

Proximity to major roads and the incidence of osteoporotic fractures in elderly women: The BONE study in Beijing

Background

There is growing evidence to suggest that living near major roads (and suffering from the air pollution of urban streets) can have an adverse effect on bone health. However, little is known about its relationship to fractures caused by osteoporosis.

Objective

This study was designed to investigate the relationship between residents living near major roads and the incidence of osteoporotic fractures.

Methods

A retrospective cohort of 529 subjects was established based on community populations in older women aged 65-91. All participants lived in Beijing between September 27, 2007 and September 26, 2017. The distance between the residential sites of the subjects and the main roads was determined by the authors. Osteoporotic fracture diagnosis was based on medical histories and imaging examinations (DXA and X-rays). The Cox proportional hazard model was used to assess the association between traffic proximity and osteoporotic fractures, with suitable adjustments for individual and background factors.

Results

The age range of all participants was 65-91 years, with an average age of 75.8 years (and a standard deviation 6.8 years). Of these, 19 (3.59%) suffered from diabetes, and 48 (9%) had hypertension; 85 (14%) families had annual incomes below US $30,000 and 402 (76%) had received a secondary school education or higher. Nearly 25% of people lived within 50 m of a main road, while 50% lived within 300 m. Between 2007 and 2017, a total of 96 osteoporotic fractures were observed. For people living <50 m from a main road, the adjusted hazard ratio (HR) for osteoporotic fractures was 2.509 (95% CI 1.345-4.680), while it was 1.830 (95% CI 1.029-3.255) for those living at a distance of 50-300 m from a main road vs. those living further than 300 m away.

Conclusion

In this community-based cohort, living near a major road was associated with a higher incidence of osteoporotic fractures.

The effect of neighborhood walkability on changes in physical activity and sedentary behavior during a 12-week pedometer-facilitated intervention

BACKGROUND

Pedometer-facilitated interventions encourage physical activity via the accumulation of steps. Mixed evidence suggests that neighborhood walkability might influence the effectiveness of physical activity interventions, including pedometer-facilitated interventions. Our study investigated the moderating effect of neighborhood walkability on immediate (4-week) and short-term (12-week) changes in self-reported neighborhood-specific leisure and transportation walking, leisure-based moderate and vigorous-intensity physical activity, and leisure-based screen time during a pedometer-facilitated intervention (UWALK).

METHODS

This quasi-experiment undertaken in Calgary (Canada) compared behavior changes during the 12-week intervention between two neighborhood groups classified as 'walkable' or 'car dependent' based on Walk Score®. Of the 573 volunteers (adults in the contemplation and preparation stages of physical activity behavior change), 466 participated in UWALK. Surveys captured sociodemographic characteristics, perceived neighborhood walkability, neighborhood preferences, motivation, physical activity and screen-based leisure. Covariate-adjusted linear mixed models estimated the differences in physical activity and leisure screen time between the neighborhood walkability groups at baseline, 4-weeks, and 12-weeks.

RESULTS

UWALK participants included mostly females (83%) and had an average age of 49.2 years. Weekly minutes of walking for transport inside the neighborhood was higher (p < .001) among participants from walkable versus car dependent neighborhoods at baseline (42.5 vs. 21.1), 4-weeks (81.2 vs. 48.2), and 12-weeks (87.2 vs. 48.0). Regardless of neighborhood walkability, all physical activity outcomes were higher and leisure screen time lower at 4-weeks and 12-weeks compared with baseline. We found no significant neighborhood group by time interactions.

CONCLUSIONS

Pedometer-facilitated interventions may be effective for supporting short-term changes in physical activity and sedentary behavior even among adults residing in low walkable neighborhoods.

Distance to sports facilities and low frequency of exercise and obesity: a cross-sectional study

Background

Little research has investigated the associations between proximity to physical activity facilities and behavior-related health and the majority have focused on proximity from home address. We add to the literature by examining proximity of these facilities to work and home address and including a wide range of physical activity facilities. We assess the associations for proximity of physical activity facilities from home and work address with self-reported frequency of exercise and obesity.

Methods

Our analytical sample of 7358 participants was from the 2018 wave of the Swedish Longitudinal Occupational Survey of Health. We used logistic binomial regression adjusting for age, sex, education, civil status, individual socioeconomic status, neighborhood socioeconomic status, number of children under 12 years of age, work strain, and chronic disease.

Results

Longer distance from home to paid outdoor and paid indoor physical activity facilities was associated with low frequency of exercise (fully adjusted Relative Risk for both 1.01, 95% CI 1.01–1.02). Associations of any or free outdoor facility with low frequency of exercise were not robust. Findings also indicated associations between long distance from workplace to any and paid outdoor facility and low frequency of exercise. Results for obesity were in the similar direction, however, these were not statistically significant.

Conclusion

Increased distance of paid outdoor and paid indoor physical activity facilities from home and of paid outdoor facilities from work was associated with low frequency of exercise. Longitudinal and larger studies are needed to confirm our findings, particularly regarding obesity.

Urban environment and physical activity and capacity in patients with chronic obstructive pulmonary disease

BACKGROUND

Physical activity and exercise capacity are key prognostic factors in chronic obstructive pulmonary disease (COPD) but their environmental determinants are unknown.

OBJECTIVES

To test the association between urban environment and objective physical activity, physical activity experience and exercise capacity in COPD.

METHODS

We studied 404 patients with mild-to-very severe COPD from a multi-city study in Catalonia, Spain. We measured objective physical activity (step count and sedentary time) by the Dynaport MoveMonitor, physical activity experience (difficulty with physical activity) by the Clinical visit-PROactive (C-PPAC) instrument, and exercise capacity by the 6-min walk distance (6MWD). We estimated individually (geocoded to the residential address) population density, pedestrian street length, slope of terrain, and long-term (i.e., annual) exposure to road traffic noise, nitrogen dioxide (NO₂) and particulate matter (PM_2.5). We built single- and multi-exposure mixed-effects linear regressions with a random intercept for city, adjusting for confounders.

RESULTS

Patients were 85% male, had mean (SD) age 69 (9) years and walked 7524 (4045) steps/day. In multi-exposure models, higher population density was associated with fewer steps, more sedentary time and worse exercise capacity (-507 [95% CI: 1135, 121] steps, +0.2 [0.0, 0.4] h/day and -13 [-25, 0] m per IQR). Pedestrian street length related with more steps and less sedentary time (156 [9, 304] steps and -0.1 [-0.1, 0.0] h/day per IQR). Steeper slope was associated with better exercise capacity (15 [3, 27] m per IQR). Higher NO₂ levels related with more sedentary time and more difficulty in physical activity. PM_2.5 and noise were not associated with physical activity or exercise capacity.

DISCUSSION

Population density, pedestrian street length, slope and NO₂ exposure relate to physical activity and capacity of COPD patients living in highly populated areas. These findings support the consideration of neighbourhood environmental factors during COPD management and the attention to patients with chronic diseases when developing urban and transport planning policies.

Barriers and facilitators of domain-specific physical activity: a systematic review of reviews

Background

Knowing what facilitates and hinders physical activity behaviour across domains (leisure, travel, work or education, and household) is central for the development of actions for more active lifestyles. Thus, the aim of this systematic review of reviews was to summarize the evidence on barriers and facilitators of domain-specific physical activity.

Methods

We included systematic reviews with or without meta-analysis that investigated the association between modifiable barriers and facilitators and levels of domain-specific physical activity. Reviews published until September 2020 were retrieved from PubMed, ISI Web of Science, Scopus, Regional Library of Medicine (BIREME), and PsycNET, and from the reference list of selected articles. Each review was screened by two independent reviewers for eligibility. Data extracted from selected papers included methodological aspects (number of primary studies, study designs, and age groups); physical activity domains and barriers and facilitators investigated; and direction of association. For each pair of barrier/facilitator and domain-specific physical activity, we recorded the number of positive, negative, and null associations reported across reviews. Quality assessment of each systematic review was performed using the AMSTAR-2 tool.

Results

Forty-four systematic reviews were selected. The evidence base was largest for leisure-time followed by travel-related physical activity. A very small number of reviews included physical activity in work, educational and domestic settings. Across all physical activity domains, factors related to the built environment were more abundant in the reviews than intra and interpersonal factors. Very consistent positive associations were observed between a range of intrapersonal factors and leisure-time physical activity, as well as moderately consistent evidence of positive association for general social support and support from family members. Evidence of moderate consistency was found for the positive association between transport-related physical activity and positive beliefs about consequences, walkability, and existence of facilities that support active travel. Evidence on barriers and facilitators for physical activity at work, educational, and domestic settings was limited in volume and consistency.

Conclusions

Efforts and resources are required to diversify and strength the evidence base on barriers and facilitators of domain-specific physical activity, as it is still limited and biased towards the leisure domain and built environment factors.

Trial registration

PROSPERO CRD42020209710.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14385-1.

The CIVISANO protocol: a mixed-method study about the role of objective and perceived environmental factors on physical activity and eating behavior among socioeconomically disadvantaged adults

BACKGROUND

Overweight and obesity have a strong socioeconomic profile. Unhealthy behaviors like insufficient physical activity and an unbalanced diet, which are causal factors of overweight and obesity, tend to be more pronounced in socioeconomically disadvantaged groups in high income countries. The CIVISANO project aims to identify objective and perceived environmental factors among different socioeconomic population groups that impede or facilitate physical activity and healthy eating behavior in the local context of two peri-urban Flemish municipalities in Belgium. We also aim to identify and discuss possible local interventions and evaluate the participatory processes of the project.

METHODS

This study (2020-2023) will use community-based participatory tools, involving collaborative partnerships with civic and stakeholder members of the community and regular exchanges among all partners to bridge knowledge development and health promotion for socioeconomically disadvantaged citizens. Furthermore, a mixed-methods approach will be used. A population survey and geographic analysis will explore potential associations between the physical activity and eating behaviors of socioeconomically disadvantaged adults (25-65 years old) and both their perceived and objective physical, food and social environments. Profound perceptive context information will be gathered from socioeconomically disadvantaged adults by using participatory methods like photovoice, walk-along, individual map creation and group model building. An evaluation of the participatory process will be conducted simultaneously.

DISCUSSION

The CIVISANO project will identify factors in the local environment that might provoke inequities in adopting a healthy lifestyle. The combination of perceived and objective measures using validated strategies will provide a robust assessment of the municipality environment. Through this analysis, the project will investigate to what extent community engagement can be a useful strategy to reduce health inequities. The strong knowledge exchange and capacity-building in a local setting is expected to contribute to our understanding of how to maximize research impact in this field and generate evidence about potential linkages between a health enhancing lifestyle among socioeconomically disadvantaged groups and their physical, food and social environments.

Perceived barriers to physical activity behaviour among patients with diabetes and hypertension in Kosovo: a qualitative study

Background

In a cohort of primary health care users across Kosovo (KOSCO cohort), high rates and poor control  of diabetes and hypertension were observed. These conditions can be prevented and better controlled by adapting to a healthy lifestyle. Physical activity is an important target, as inactivity and related obesity were very prevalent in the KOSCO cohort. This qualitative study aims to identify individual and structural barriers to physical activity perceived by patients with diabetes and/or hypertension so as to inform health care providers and policy-makers in Kosovo on strategies for promoting physical activity.

Methods

Interviews were conducted from July to October 2020 with 26 public primary health care users from five municipalities of Kosovo (Mitrovica, Vushtrri, Fushe Kosova, Gjakova, and Malisheva). The qualitative study was nested into the KOSCO cohort. KOSCO was implemented in 2019 and recruited consecutive patients visiting the public primary health care centres in these municipalities. Participants of this qualitative sub-study were selected if they had a doctor’s diagnosis of diabetes and/or hypertension. The interview guide consisted of questions related to physical activity barriers these patients are facing, despite having received motivational counselling sessions in primary healthcare centres. Data were analysed using a framework methodology.

Results

Three main themes moderating physical activity behaviour were identified: 1) neighbourhood built environment, 2) health-related problems, and 3) social support. The barriers to physical activity related to the first theme were structural features of the neighbourhoods such as: crowded sidewalks, lack of green spaces, lack of proper lighting in public spaces, as well as dense traffic. In regards to the second theme, the main health reasons for study participants to delay physical activity were related to: physical discomfort as well as stress, worry, and lack of energy. An additional barrier to exercise was lack of social support specifically from friends.

Conclusion

The study identifies structural and individual targets for integrated and inter-sectoral physical activity promotion efforts.

The neighbourhood built environment and health-related fitness: a narrative systematic review

Background

There is increasing evidence demonstrating the importance of the neighbourhood built environment in supporting physical activity. Physical activity provides numerous health benefits including improvements in health-related fitness (i.e., muscular, cardiorespiratory, motor, and morphological fitness). Emerging evidence also suggests that the neighbourhood built environment is associated with health-related fitness. Our aim was to summarize evidence on the associations between the neighbourhood built environment and components of health-related fitness in adults.

Methods

We undertook a systematic review following PRISMA guidelines. Our data sources included electronic searches in MEDLINE, Embase, CINAHL, Web of Science, SPORTDiscus, Environment Complete, ProQuest Dissertations and Theses, and Transport Research International Documentation from inception to March 2021. Our eligibility criteria consisted of observational and experimental studies estimating associations between the neighbourhood built environment and health-related fitness among healthy adults (age ≥ 18 years). Eligible studies included objective or self-reported measures of the neighbourhood built environment and included either objective or self-reported measures of health-related fitness. Data extraction included study design, sample characteristics, measured neighbourhood built environment characteristics, and measured components of health-related fitness. We used individual Joanna Briggs Institute study checklists based on identified study designs. Our primary outcome measure was components of health-related fitness (muscular; cardiorespiratory; motor, and morphological fitness).

Results

Twenty-seven studies (sample sizes = 28 to 419,562; 2002 to 2020) met the eligibility criteria. Neighbourhood destinations were the most consistent built environment correlate across all components of health-related fitness. The greatest number of significant associations was found between the neighbourhood built environment and morphological fitness while the lowest number of associations was found for motor fitness. The neighbourhood built environment was consistently associated with health-related fitness in studies that adjusted for physical activity.

Conclusion

The neighbourhood built environment is associated with health-related fitness in adults and these associations may be independent of physical activity. Longitudinal studies that adjust for physical activity (including resistance training) and sedentary behaviour, and residential self-selection are needed to obtain rigorous causal evidence for the link between the neighbourhood built environment and health-related fitness.

Trial registration

Protocol registration: PROSPERO number CRD42020179807.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01359-0.

Associations between neighborhood built environment, residential property values, and adult BMI change: The Seattle Obesity Study III

Objective

To examine associations between neighborhood built environment (BE) variables, residential property values, and longitudinal 1- and 2-year changes in body mass index (BMI).

Methods

The Seattle Obesity Study III was a prospective cohort study of adults with geocoded residential addresses, conducted in King, Pierce, and Yakima Counties in Washington State. Measured heights and weights were obtained at baseline (n = 879), year 1 (n = 727), and year 2 (n = 679). Tax parcel residential property values served as proxies for individual socioeconomic status. Residential unit and road intersection density were captured using Euclidean-based SmartMaps at 800 m buffers. Counts of supermarket (0 versus. 1+) and fast-food restaurant availability (0, 1–3, 4+) were measured using network based SmartMaps at 1600 m buffers. Density measures and residential property values were categorized into tertiles. Linear mixed-effects models tested whether baseline BE variables and property values were associated with differential changes in BMI at year 1 or year 2, adjusting for age, gender, race/ethnicity, education, home ownership, and county of residence. These associations were then tested for potential disparities by age group, gender, race/ethnicity, and education.

Results

Road intersection density, access to food sources, and residential property values were inversely associated with BMI at baseline. At year 1, participants in the 3rd tertile of density metrics and with 4+ fast-food restaurants nearby showed less BMI gain compared to those in the 1st tertile or with 0 restaurants. At year 2, higher residential property values were predictive of lower BMI gain. There was evidence of differential associations by age group, gender, and education but not race/ethnicity.

Conclusion

Inverse associations between BE metrics and residential property values at baseline demonstrated mixed associations with 1- and 2-year BMI change. More work is needed to understand how individual-level sociodemographic factors moderate associations between the BE, property values, and BMI change.

•

Strong, inverse cross-sectional relationships between the built environment, residential property values (a proxy for individual socioeconomic status), and measured BMI were observed.

•

Measures of the built environment and residential property values showed modest and inconsistent associations with 1- and 2-year BMI change.

•

There was suggestive evidence that age may moderate the association between urban density and 1- and 2-year BMI change while education may moderate the association between residential property values and 2-year BMI change.

The association between the built environment and intervention-facilitated physical activity: a narrative systematic review

Background

A diverse range of interventions increase physical activity (PA) but few studies have explored the contextual factors that may be associated with intervention effectiveness. The built environment (BE) may enhance or reduce the effectiveness of PA interventions, especially interventions that encourage PA in neighbourhood settings. Several studies have investigated the effects of the neighbourhood BE on intervention-facilitated PA, however, a comprehensive review of evidence has yet to be conducted. In our systematic review, we synthesize evidence from quantitative studies that have examined the relationships between objectively-measured neighbourhood BE and intervention-facilitated PA in adults.

Method

In October 2021, we searched 7 databases (Medline, CINAHL, Embase, Web of Science, SPORTDiscus, Environment Complete, and Cochrane Central Register of Controlled Trials) for English-language studies reporting on randomized and non-randomized experiments of physical activity interventions involving adults (≥18 years) and that estimated the association between objectively-measured BE and intervention-facilitated physical activity.

Results

Twenty articles, published between 2009 and 2021, were eligible for inclusion in the review.

Among the 20 articles in this review, 13 included multi-arm experiments and 7 included single-arm experiments. Three studies examined PA interventions delivered at the population level and 17 examined interventions delivered at the individual level. PA intervention characteristics were heterogeneous and one-half of the interventions were implemented for at least 12-months (n = 10). Most studies were undertaken in North America (n = 11) and most studies (n = 14) included samples from populations identified as at risk of poor health (i.e., metabolic disorders, coronary heart disease, overweight, cancer, high blood pressure, and inactivity). Fourteen studies found evidence of a neighbourhood BE variable being negatively or positively associated with intervention-facilitated PA.

Conclusion

Approximately 70% of all studies reviewed found evidence for an association between a BE variable and intervention-facilitated PA. The BE’s potential to enhance or constrain the effectiveness of PA interventions should be considered in their design and implementation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01326-9.

Developing non-exercise activity thermogenesis (NEAT) through building design

Purpose

Physical inactivity has a considerable negative impact on health. Physical activity has reduced partly due to workplace and lifestyle changes, causing people to spend more time in buildings and increasing sedentary behaviour. The purpose of this paper is to address a largely untapped opportunity for designers and managers to improve building users’ health by designing buildings that raise users’ Non-Exercise Activity Thermogenesis (NEAT) levels. In this research a conceptual model was developed to assess buildings’ performance in providing NEAT-promoting opportunities through building design features and management, in relation to building users’ propensity for NEAT behaviours.

Design/methodology/approach

The conceptual model was developed by a multi-disciplinary team of researchers and data to populate the model was obtained through a survey of 75 buildings in Jakarta (Indonesia).

Findings

The presented proof-of-concept shows that the model’s “meso-scale” approach to study physical activity and building design can lead to potential improvements of NEAT levels and physical activity in buildings.

Originality/value

The review of precedent models shows that this subject has been researched at micro-scale (i.e. detailed monitoring of individuals’ movement) and macro-scale (i.e. epidemiological studies of populations’ health). The presented model is original, as it explores a “meso-scale”(i.e. building scale) that is unique.

Examining the Built Environment for Healthy Living via Virtual Street Audits

During the fall 2019 and spring 2020 semesters, 156 MPH students enrolled in the Integrative Learning Experience at the University of Alabama at Birmingham School of Public Health explored concepts of the built environment and health by auditing 2500 street segments in 4 urban neighborhoods in Birmingham, Alabama. In teams of 4 to 5, in-class and online students worked collaboratively to assess 63 built environment variables related to transportation, land use, advertisement, and neighborhood physical disorder. This type of "community assessment" is the first stage of the Evidence-based Public Health Framework and consistent with the applied nature of an MPH degree. Authors conducted secondary data analysis of final team assignments to demonstrate how students translated observations and ratings into practical recommendations for neighborhood improvements to promote physical activity. Students recommended improvements in neighborhood infrastructure and services, specifically: creating exercise space, providing outdoor exercise equipment, improving neighborhood safety, and cultivating a culture of health. The Integrative Learning Experience course encouraged students to use their knowledge and skills to prioritize recommendations to improve neighborhood conditions. Variable ratings and observations increased student awareness of the built environment and its potential to impact individual and community health. Moreover, the project helped students make connections between proximal outcomes, such as improving neighborhood walkability, and distal outcomes, such as improved health outcomes among residents. Finally, this project modeled for students the use of evidence-based strategies for making data-informed decisions, which are essential skills for new and emerging public health professionals.

Interweaving Adult Fitness Classes Into Community Settings Via Stronger Austin's Community Partnership Model: Increasing Access to Physical Activity and Positive Social Connectedness in Underserved Communities

The lack of environmental supports for healthy lifestyles is a potent factor in the high prevalence of noncommunicable diseases among communities experiencing economic disadvantage. Stronger Austin aimed to increase access to free physical activity (PA) and fitness programming (eg, Zumba) in underserved communities in Austin, Texas, via a partnership and interweaving into context approach in which classes are interwoven into settings with widespread access for residents, including clinics, city-supported housing, parks, recreation centers, and schools. We aimed to better understand the PA-related benefits and opportunities for improvement when adult fitness classes are interwoven into community settings. A mixed-methods design guided the study, which included SOFIT (Structured Observation of Fitness Instruction Time) assessments of class PA (n = 160 participants) and qualitative assessment of highlights and recommendations for class improvement via participant focus groups (n = 24), open-ended questionnaires (n = 258), and instructor interviews (n = 6). Findings indicated high levels of class PA (76.9%-86.9% of 1-hour class spent in moderate-to-vigorous PA; mean of 18 participants per class), with positive social connectedness cited as a key benefit. Challenges and best practices of community-based fitness classes are explored. Stronger Austin's partnership and interweaving into context approach represents a promising model for increasing access to fitness classes in underserved communities.

Does the longitudinal association between neighbourhood cohesion and mental health differ by ethnicity? Results from the UK Household Longitudinal Survey

PURPOSE

While the association between neighbourhood cohesion and mental health has been widely studied in the general population, the effects of neighbourhood cohesion across ethnic groups are not well understood. Ethnicity is often left out of study design, many studies do not consider effect modification by ethnicity, or they rely on overly simplistic ethnic categories.

METHODS

Data from the UK household longitudinal study were used to investigate whether changes in neighbourhood cohesion are independently associated with changes in mental health (measured using the GHQ) over 9 years (2009-2018), and whether the association differed across 17 ethnic groups. The study used a fixed-effect modeling approach that includes within-person estimators that allow each participant to act as their own control.

RESULTS

Compared to British White, the following ethnic groups all saw a similar improvement in GHQ (- 0.76, 95% CI - 0.83 to - 0.70) for each point increase in neighbourhood cohesion: Irish, any other White, White and Asian mixed, Chinese, Caribbean, African, any other Black, Arab, and others. Some ethnic groups saw stronger improvements in mental for each point increase in neighbourhood cohesion, including White and Black Caribbean mixed, any other mixed, Indian, Pakistani, any other Asian, with the strongest effect seen in Bangladeshi participants (- 2.52. 95% CI - 3.48 to - 1.56).

CONCLUSION

Our study highlights the importance of ethnocultural data in research examining neighbourhood effects on mental health. Future research should evaluate policies to improve neighbourhood cohesion for ethnic minorities to address ethnic mental health disparities.

Profiling the variability and inequity in the residential environment in Cyprus according to citizens' ratings: a cross-sectional internet-based "Place Standard" survey

Background

The “Place Standard Tool” (PST) offers a practical framework for structuring conversations about physical and social dimensions of Place which impact on health and well-being. The aim of this study was to survey citizens’ perceptions of Place across diverse settings in Cyprus. While the PST has been extensively used in the context of community engagement, its properties as a measurement tool haven’t been explored.

Methods

An open call was addressed to citizens to rate their neighbourhood environment across the 14 PST items (1: large to 7: little room for improvement). Exploratory factor, cluster and regression analyses were used to explore the dimensionality of the scale, depict neighbourhood profiles and explore differences in ratings according to socio-demographic characteristics, area-level census indicators and residents’ assessment of neighbourhood social position (10-step ladder).

Results

With the exception of safety (M = 4.4, SD = 1.7), 492 participants (mean age 42, 50% residents for > 10 years) from 254 postcodes (21.7% islandwide) did not rate other features favourably, with lowest scores for “influence and sense of control” and “public transport”. A stepwise pattern of dissatisfaction was observed along the social position continuum both for features rated less as well as more favourably (e.g. social contact). For instance, among participants who placed their neighbourhood at the three top steps of the ladder, 48.8% gave a low rating for “influence and sense of control”, while the equivalent figure was 81.0% at the bottom three steps (OR = 4.5, 95% CI 2.3, 8.6). A clear dimensionality of Built (6 items, Cronbach’s α = 0.798), Physical (3 items, α = 0.765), Social (2 items, α = 0.749) and Service (3 items, α = 0.58) environment was identified. A social gradient was evident according to census measures of socio-economic disadvantage (e.g. pre-1980 housing, single-parent households) with larger differences in terms of the built than the social environment.

Conclusions

The study profiled the variability and documented the inequity in the health-related neighbourhood environment across Cypriot communities. The readily interpretable dimensionality of the scale supports its construct validity, allowing calculation of composite scores. The PST can be used as measurement tool in research as well as public health practice to advocate for neighbourhood initiatives which support and enhance citizens’ participation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12706-y.

The effects of the built environment on the general health, physical activity and obesity of adults in Queensland, Australia

The built environment has been identified as a key factor for health intervention and obesity prevention. However, it is still unclear to what extent the built environment is associated with obesity and general health and to what extent such an association is mediated through variation in physical activity. This study aims to examine the associations between individual characteristics, the built environment, physical activity, general health and body mass index to reveal the pathways through which the built environment is associated with the prevalence of obesity. Using data from 1,788 adults aged 18 to 65 in Queensland from Wave 16 of the Household, Income, and Labour Dynamics in Australia survey, we use geographic information system-based methods to quantify built environment factors in 5D dimensions: Density, Diversity, Design, Distance and Destination accessibility. We then employ multi-level mixed-effect models to test the hypothesised relationships between individual characteristics, the built environment, physical activity, general health and body mass index. The results indicate that physical activity is positively associated with general health and negatively associated with the prevalence of obesity. Adjusting for individual characteristics, we find that built-environment factors have direct effects on physical activity but indirect effects on general health and obesity. Among these factors, greater green space exposure plays a key role in enhancing general health and reducing obesity. Low-density and car-dependent neighbourhoods can be activity-friendly and mitigate obesity if these neighbourhoods are also equipped with easy access to green space.

Does the built environment have independent obesogenic power? Urban form and trajectories of weight gain

OBJECTIVE

To determine whether selected features of the built environment can predict weight gain in a large longitudinal cohort of adults.

METHODS

Weight trajectories over a 5-year period were obtained from electronic health records for 115,260 insured patients aged 18-64 years in the Kaiser Permanente Washington health care system. Home addresses were geocoded using ArcGIS. Built environment variables were population, residential unit, and road intersection densities captured using Euclidean-based SmartMaps at 800-m buffers. Counts of area supermarkets and fast food restaurants were obtained using network-based SmartMaps at 1600, and 5000-m buffers. Property values were a measure of socioeconomic status. Linear mixed effects models tested whether built environment variables at baseline were associated with long-term weight gain, adjusting for sex, age, race/ethnicity, Medicaid insurance, body weight, and residential property values.

RESULTS

Built environment variables at baseline were associated with differences in baseline obesity prevalence and body mass index but had limited impact on weight trajectories. Mean weight gain for the full cohort was 0.06 kg at 1 year (95% CI: 0.03, 0.10); 0.64 kg at 3 years (95% CI: 0.59, 0.68), and 0.95 kg at 5 years (95% CI: 0.90, 1.00). In adjusted regression models, the top tertile of density metrics and frequency counts were associated with lower weight gain at 5-years follow-up compared to the bottom tertiles, though the mean differences in weight change for each follow-up year (1, 3, and 5) did not exceed 0.5 kg.

CONCLUSIONS

Built environment variables that were associated with higher obesity prevalence at baseline had limited independent obesogenic power with respect to weight gain over time. Residential unit density had the strongest negative association with weight gain. Future work on the influence of built environment variables on health should also examine social context, including residential segregation and residential mobility.

Associations between neighbourhood built characteristics and sedentary behaviours among Canadian men and women: findings from Alberta's Tomorrow Project

Evidence of associations between neighbourhood built characteristics and sedentary behaviours is mixed. The study aim was to investigate the associations between objectively-derived neighbourhood built characteristics and self-reported sedentary behaviours among Canadian men and women. This study sourced survey data from Alberta's Tomorrow Project (2008; n = 14,785), in which sitting and motor vehicle travel times during the last 7 days was measured. Geographic Information System was used to calculate neighbourhood built characteristics within a 400 m buffer of participant's home and a walkability score was estimated. To estimate the associations between neighbourhood characteristics and sedentary behaviours, covariate-adjusted generalized linear regression models were used. Walkability, 3-way intersections, and population count were positively associated with sitting time. Business destinations and greenness were negatively associated with sitting time. Walkability, 3-way, and 4-way intersections were negatively associated with motor vehicle travel time. Sex-specific associations between neighbourhood characteristics and sedentary behaviour were found. Among men, business destinations were negatively associated with sitting time, and 3-way intersections, population count, and walkability were negatively associated with motor vehicle travel time. Among women, Normalized Difference Vegetation Index was negatively associated with sitting time. Interventions to reduce sedentary behaviours may need to target neighbourhoods that have built characteristics which might support these behaviours. More research is needed to disentangle the complex relationships between different neighbourhood built characteristics and specific types of sedentary behaviour.

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

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

Quality of life in Brazilian martial arts and combat sports practitioners

Study aim: Martial arts and combat sports have been an alternative for individuals seeking the health benefits of physical activity and exercise, but little is known about its practitioners’ quality of life. Therefore, this study aimed to investigate the quality of life of practitioners of five of the most common modalities in Brazil.

Material and methods: A total of 922 young men, competitive and recreational practitioners of Brazilian jiu-jitsu, judo, karate, kung-fu, and taekwondo, answered the Brazilian version of the WHOQOL-BREF questionnaire.

Results: The results for each domain – physical, psychological, social, and environmental – are, respectively, as follow (mean ± standard deviation): Brazilian jiu-jitsu: 74 ± 11, 75 ± 12, 77 ± 17, 67 ± 14; judo: 74 ± 13, 75 ± 12, 77 ± 15, 64 ± 12; karate: 76 ± 13, 75 ± 12, 78 ± 15, 64 ± 13; kung-fu: 77 ± 13, 75 ± 13, 74 ± 17, 65 ± 13; taekwondo: 76 ± 12, 76 ± 11, 78 ± 16, 64 ± 13; total: 75 ± 13, 75 ± 12, 77 ± 16, 65 ± 13. There was no difference between modalities and no interaction between modalities and experience level. All groups and the total sample presented higher values than the normative national data in the physical and psychological domains. This was also the case for the judo, karate, and taekwondo groups, as well as the total sample in the social domain, and for the Brazilian jiu-jitsu and the whole sample in the environmental domain. Additionally, in the whole sample competitors scored higher than recreational practitioners in the psychological domain.

Conclusion: These findings reveal that the practice of these modalities is associated with higher quality of life than the normative values. Longitudinal studies are warranted for a better understanding of this association.

GPS-based built environment measures associated with adult physical activity

Studies often rely on home locations to access built environment (BE) influences on physical activity (PA). We use GPS and accelerometer data collected for 288 individuals over a two-week period to examine eight GPS-derived BE characteristics and moderate-to-vigorous PA (MVPA) and light-to-moderate-vigorous PA (LMVPA). NDVI, parks, blue space, pedestrian-orientated intersections, and population density were associated with increased odds of LMVPA and MVPA, while traffic air pollution and noise were associated with decreased odds of LMVPA and MVPA. Associations varied by population density and when accounting for multiple BE measures. These findings provide further information on where individuals choose to be physically active.

Environmental Preferences and Concerns of Recreational Road Runners

Recreational road running is growing in popularity and has been linked to numerous mental and physical health benefits. However, we know little about what environmental preferences or concerns runners have regarding participation in the sport, and whether differences exist across age and gender. We conducted a cross-sectional survey on recreational road runners to investigate the type of built and natural environments road runners prefer, as well as the safety and health concerns that may affect runners’ choice of environment. Responses were analyzed by age and gender. A total of 1228 road runners responded to the survey; 59.6% of respondents were women and 32.1% of respondents were men. Most respondents preferred to run on asphalt or sidewalk surfaces, and preferred well-lit, tree-lined routes. Major concerns for both men and women include animals and dangerous road conditions. Men and women differed significantly in their responses to the importance of running around others and their primary concerns while running. Results of this study serve to deepen our understanding of recreational road runners’ environmental preferences and concerns, providing valuable information for public health officials and city planners alike. This information must be considered if we are to continue to encourage uptake of running as a sport and reap its health effects.

A longitudinal residential relocation study of changes in street layout and physical activity

Few longitudinal residential relocation studies have explored associations between urban form and physical activity, and none has used the Space Syntax theory. Using a Canadian longitudinal dataset (n = 5944), we estimated: (1) differences in physical activity between non-movers, and those relocating to neighbourhoods with less or more integrated street layouts, and; (2) associations between changes in street layout integration exposure and differences in physical activity. Adjusting for covariates, we found relative to non-movers, those who moved to more integrated neighbourhoods undertook significantly (p < .05) more leisure walking (27.3 min/week), moderate-intensity (45.7 min/week), and moderate-to-vigorous intensity physical activity (54.4 min/week). Among movers, a one-unit increase in the relative change in street integration exposure ([Street integration at follow-up—street integration at baseline]/street integration at baseline) was associated with a 7.5 min/week increase in leisure walking. Our findings suggest that urban design policies that improve neighbourhood street integration might encourage more physical activity in adults.

Associations between the built environment and dietary intake, physical activity, and obesity: A scoping review of reviews

There exists a large body of literature examining the association between built environment factors and dietary intake, physical activity, and weight status; however, synthesis of this literature has been limited. To address this gap, we conducted a scoping review of reviews and identified 74 reviews and meta-analyses that investigated the association between built environment factors and dietary intake, physical activity, and/or weight status. Results across reviews were mixed, with heterogeneous effects demonstrated in terms of strength and statistical significance; however, preliminary support was identified for several built environment factors. For example, quality of dietary intake appeared to be associated with the availability of grocery stores, higher levels of physical activity appeared to be most consistently associated with greater walkability, and lower weight status was associated with greater diversity in land-use mix. Overall, reviews reported substantial concern regarding methodological limitations and poor quality of existing studies. Future research should focus on improving study quality (e.g., using longitudinal methods, including natural experiments, and newer mobile sensing technologies) and consensus should be drawn regarding how to define and measure both built environment factors and weight-related outcomes.

Physical activity participation among Arab immigrants and refugees in Western societies: A scoping review

Insufficient physical activity (PA) is the fourth prime risk factor for numerous non-communicable diseases. Arab immigrants and refugees (AIR) are at elevated risk for low or no participation in PA due to socio-cultural and ecological factors. This scoping review examined PA prevalence, knowledge, attitudes as well as barriers vs. facilitators to PA engagement across life domains among AIR in Western countries. A systematic search strategy was implemented across five automated databases (PubMed, Embase, Medline, Sociology Database and Transportation Research Board) to locate pertinent English language papers. Seventy-five articles were included in this study, and stakeholder consultation was conducted to validate the findings. The US and Europe are substantially ahead of Canada, Australia, and New Zealand in AIR-PA research. Despite showing positive attitudes and sound knowledge of PA recommendations, AIR exhibited a low PA engagement prevalence, revealing a knowledge-compliance gap. The prevalence of sufficient PA was lowest in the US (11-22%), whereas Europe showed the highest figures (26-45%). Personal barriers to PA participation involved mainstream language illiteracy and limited exercise skills, whereas improved PA literacy was a significant facilitator. Family responsibility and cultural restrictions were common psychosocial/cultural barriers, whereas social support and culturally-sensitive resources were powerful facilitators. Poorly maintained pedestrian/cyclist infrastructure was a leading environmental barrier amongst AIR in North America, but not Europe. Longitudinal and community-engaged AIR-PA research is needed, and intersectoral collaboration is required to inform tailored interventions and inclusive policies, fostering AIR and other vulnerable populations' exercise participation and improving their health and well-being.

'It's just one of those natural progressions': Stories of relocating to neighbourhoods of high and low walkability

Walkable neighbourhood characteristics, such as connectivity and land use mix, have been found to correlate with people walking more and being active. However, the relationship between the built environment and behaviour is highly complex making it difficult to develop generalisable and predictive models. This paper reports qualitative findings from 21 in-depth interviews conducted with urban residents who had relocated between neighbourhoods of high and low walkability. Participants' preferences are reported within key domains (shop access, green space and travel links). These reveal that walkable characteristics were preferred and desired regardless of whether the participant had moved to a high or low walkable area. We contrast surface preferences with an analysis of relocation stories: complex assemblages of biographical narratives, identity work and cultural representations. The findings reveal how neighbourhood types are consistently associated with life stages and that moving to a suburban home was felt to be a definitive type of relocation in which it was acceptable to put neighbourhood preferences aside. Residential self-selection is not yet properly understood and we recommend studies of relocation stories for examining the sociocultural meanings that are likely to inform relocation decisions.

An ecological approach to the development of an active aging measurement in urban areas (AAMU)

BACKGROUND

An essential element in the process of "aging well" is the concept of Active Aging (AA). To propose an operational definition of Active Aging, the present study seeks to develop a new measurement tool through an ecological approach. The aim is to recognize significant indicators that play a role in assessing AA in urban areas.

METHODS

This study was conducted through a two-phase process of consensus-building: 1) identifying a set of indicators that were likely candidates for inclusion based on literature review, and 2) a two-round modified Delphi survey using an international panel of academic experts in environmental sciences and gerontology to achieve consensus on the importance of the extracted indicators and validate the items. The panelists were asked to complete a researcher-developed questionnaire with an 11-point Likert scale based on the indicators derived in phase 1. Finally, the Delphi survey's valid indicators and criteria were utilized to develop the measurement tool.

RESULTS

At the outset, a list of 111 indicators of AA was prepared through the desk study. A panel of 22 experts reviewed the extracted items and arrived at a consensus on 99 items in the first round and finalised in the second round. Thematic analysis of the panelists' open-ended responses revealed new concepts that would be explicitly considered by the consensus group. This developed measurement scale consists of five domains, i.e., individual, spatial, socio-economic, governance, and health-related, which contain 15 criteria and 99 indicators.

CONCLUSIONS

The present researchers have developed the active aging measure for urban settlements (AAMU), which can be used both by policy-makers and as an informal self-reported statement among the elderly. AAM's results in the elderly's residential environmental communities can improve policy-making to address urban design to sustain an active, healthy life among older people in urban environments.

Realtors' Perceptions of Social and Physical Neighborhood Characteristics Associated with Active Living: A Canadian Perspective

Realtors match home-seekers with neighborhoods that have built and social characteristics they desire to pursue active lifestyles. Studies have yet to explore realtors’ perspectives on neighborhood design that supports active living. Using qualitative description, our study was to explore the perceptions and understandings of neighborhood design (walkability, healthy, bike-ability, vibrancy, and livability) among urban residential realtors. Nineteen (6 men; 13 women; average age 48 years) self-identified residential realtors from Calgary, Edmonton, and Lethbridge (Canada) completed semi-structured telephone interviews. Content analysis identified themes from the interview data. Specifically, walkability was described as: perceived preferences, destinations and amenities, and connections; a healthy community was described as: encourages outdoor activities, and promotes social homogeneity; bike-ability was described as: bike-ability attributes, and was controversial; vibrancy was described as: community feel, and evidence of life; and livability was described as: subjective, and preferences and necessities. Our findings can inform the refinement of universal definitions and concepts used to in neighborhood urban design.

Perceived neighbourhood characteristics and depressive symptoms: Potential mediators and the moderating role of employment status

Multiple neighbourhood characteristics have been linked to depressive symptoms. However, few studies have simultaneously considered multiple mechanisms that explain this relationship, and how they might interact. Further, most studies regard exposure to the residential environment as constant, and therefore disregard variation in exposure by individual factors. This study investigates whether and to what extent stress and physical activity mediate the association between neighbourhood characteristics and depression, and also to what extent employment status moderates this relationship. A population-representative survey of n = 11,505 people in the Netherlands was conducted. Depressive symptoms were measured using the Patient Health Questionnaire (PHQ-9). Neighbourhood characteristics were perceived green and blue space, pleasantness, environmental disturbance, social cohesion and safety. Employment status was combined with place of work to establish two groups: those who were non-working or who worked from home ('at home'), and those who worked somewhere outside of the home ('working'). Multi-group structural equation modelling was employed to understand the theorised relationships for both groups. Perceived environmental disturbance, social cohesion and safety were significantly indirectly related to depressive symptoms via stress, with larger effect sizes in the 'at home' group. Pleasantness was also significantly indirectly related to depressive symptoms via stress, in the 'at home' group only. There was no evidence for physical activity as a mediator. Our findings suggest that neighbourhood social characteristics may have a greater influence on depressive symptoms than physical characteristics. Stress appears to be a key mediator of this relationship. In addition, the neighbourhood appears to exert a greater influence on those who spend more time in their neighbourhood. Interventions to promote mental health should focus on the social environment, and in particular pay attention to those who are spatially confined in poorer quality neighbourhoods.

Active design of built environments for increasing levels of physical activity in adults: the ENABLE London natural experiment study

Background

Low physical activity is widespread and poses a serious public health challenge both globally and in the UK. The need to increase population levels of physical activity is recognised in current health policy recommendations. There is considerable interest in whether or not the built environment influences health behaviours, particularly physical activity levels, but longitudinal evidence is limited.

Objectives

The effect of moving into East Village (the former London 2012 Olympic and Paralympic Games Athletes’ Village, repurposed on active design principles) on the levels of physical activity and adiposity, as well as other health-related and well-being outcomes among adults, was examined.

Design

The Examining Neighbourhood Activities in Built Environments in London (ENABLE London) study was a longitudinal cohort study based on a natural experiment.

Setting

East Village, London, UK.

Participants

A cohort of 1278 adults (aged ≥ 16 years) and 219 children seeking to move into social, intermediate and market-rent East Village accommodation were recruited in 2013–15 and followed up after 2 years.

Intervention

The East Village neighbourhood, the former London 2012 Olympic and Paralympic Games Athletes’ Village, is a purpose-built, mixed-use residential development specifically designed to encourage healthy active living by improving walkability and access to public transport.

Main outcome measure

Change in objectively measured daily steps from baseline to follow-up.

Methods

Change in environmental exposures associated with physical activity was assessed using Geographic Information System-derived measures. Individual objective measures of physical activity using accelerometry, body mass index and bioelectrical impedance (per cent of fat mass) were obtained, as were perceptions of change in crime and quality of the built environment. We examined changes in levels of physical activity and adiposity using multilevel models adjusting for sex, age group, ethnic group, housing sector (fixed effects) and baseline household (random effect), comparing the change in those who moved to East Village (intervention group) with the change in those who did not move to East Village (control group). Effects of housing sector (i.e. social, intermediate/affordable, market-rent) as an effect modifier were also examined. Qualitative work was carried out to provide contextual information about the perceived effects of moving to East Village.

Results

A total of 877 adults (69%) were followed up after 2 years (mean 24 months, range 19–34 months, postponed from 1 year owing to the delayed opening of East Village), of whom 50% had moved to East Village; insufficient numbers of children moved to East Village to be considered further. In adults, moving to East Village was associated with only a small, non-significant, increase in mean daily steps (154 steps, 95% confidence interval –231 to 539 steps), more so in the intermediate sector (433 steps, 95% confidence interval –175 to 1042 steps) than in the social and market-rent sectors (although differences between housing sectors were not statistically significant), despite sizeable improvements in walkability, access to public transport and neighbourhood perceptions of crime and quality of the built environment. There were no appreciable effects on time spent in moderate to vigorous physical activity or sedentary time, body mass index or percentage fat mass, either overall or by housing sector. Qualitative findings indicated that, although participants enjoyed their new homes, certain design features might actually serve to reduce levels of activity.

Conclusions

Despite strong evidence of large positive changes in neighbourhood perceptions and walkability, there was only weak evidence that moving to East Village was associated with increased physical activity. There was no evidence of an effect on markers of adiposity. Hence, improving the physical activity environment on its own may not be sufficient to increase population physical activity or other health behaviours.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 12. See the NIHR Journals Library website for further project information. This research was also supported by project grants from the Medical Research Council National Prevention Research Initiative (MR/J000345/1).