Impact of the Built Environment and the Neighborhood in Promoting the Physical Activity and the Healthy Aging in Older People: An Umbrella Review

Association between Young People's Neighbourhoods' Characteristics and Health Risk Factors in Saudi Arabia

INTRODUCTION

A neighbourhood's environmental characteristics can positively or negatively influence health and well-being. To date, no studies have examined this concept in the context of Saudi Arabian youth. Therefore, this study aimed to evaluate the association between a neighbourhood's environmental characteristics and health risk factors among Saudi Arabian youth.

METHODS

A total of 335 secondary-school students (175 males, 160 females), aged 15-19 years old, participated. Body mass index (BMI) and waist circumference measurements were taken, and physical activity (steps) was measured via pedometer. The perceived neighbourhood environment was assessed using the International Physical Activity Questionnaire Environment Module (IPAQ-E).

RESULTS

Significant differences were found between the youths from urban, rural farm, and rural desert locations in terms of BMI, waist circumference, daily steps, accessibility, infrastructure, social environment, household vehicles, safety, and access to facilities (p < 0.001). Rural desert youths were less active, and males (26.43 + 8.13) and females (24.68 + 5.03) had higher BMIs compared to the youths from other areas. Chi-square analysis revealed a significant difference (χ21 = 12.664, p < 0.001) between the genders as to social-environment perceptions. Males perceived their neighbourhood as a social environment more than was reported by females (68.39% and 50.28%, respectively). Pearson's correlation revealed negative significant relationships between steps and both safety of neighbourhood (r = -0.235, p < 0.001) and crime rate (r = -0.281, p < 0.001).

DISCUSSION

Geographical location, cultural attitudes, lack of facilities, and accessibility impact youth physical-activity engagement and weight status; this includes environmental variables such as residential density, neighbourhood safety, household motor vehicles, and social environment.

CONCLUSIONS

This is the first study examining associations with neighbourhood environments in the youths of the Kingdom of Saudi Arabia. Significant associations and geographical differences were found. More research and policy interventions to address neighbourhoods' environmental characteristics and health risk factors relative to Saudi Arabian youth are warranted.

The built environment and cancer survivorship: A scoping review

BACKGROUND

There are more than 32 million cancer survivors worldwide. The built environment is one of the contextual factors that may influence cancer survivorship. However, studies investigating the interdisciplinary field of the built environment and cancer survivorship are lacking.

OBJECTIVE

To conduct a systematic review of the existing literature regarding the relationship between the built environment and cancer survivorship, identify any knowledge gaps, and recommend future research directions.

METHODS

A systematic literature search was performed by searching OVID Medline, Embase, CINAHL, and Web of Science Core Collection.

RESULTS

Of 4235 unique records identified, 26 studies met eligibility criteria. Neighborhood walkability and greenness were the most examined built environment characteristics among the included studies. Walkability was found to be associated with various cancer survivorship experience, including increased levels of physical activity, lowered body mass index, and improved quality of life. The association between greenness and cancer survivorship outcomes were inconsistent across the included studies. Additionally, studies have reported the relationship between light and noise pollution and sleep among cancer survivors. Regarding blue space, in one qualitative study, breast cancer survivors brought up the healing properties of water.

CONCLUSION

Our scoping review demonstrated a breadth of current cancer survivorship research in the field of neighborhood walkability and greenness, but fewer studies detailing other aspects of the built environment as defined by this review, such as light pollution, noise pollution, and blue space. We identified future research directions for those interested in this interdisciplinary field, which can provide insights for urban planners and policy makers on how to best leverage the built environment to promote the health and wellbeing of cancer survivors.

1 km of living area: age differences in the association between neighborhood environment perception and self-rated health among Chinese people

OBJECTIVES

This study aimed to explore the age differences in the relationship between neighborhood environment perception and self-rated health among Chinese people.

STUDY DESIGN

This is cross-sectional study.

METHODS

The participants were 2,631 residents aged 18 and above from 2021 Chinese General Social Survey (CGSS). Self-rated health was reported by residents. Neighborhood environment was measured by respondents' subjective perception of 1 km living area. Ordered logit regression models were used to examine the relationship between neighborhood environment perception and self-rated health.

RESULTS

In summary, 42.08% were classified as young adults, and 57.92% were classified as middle-aged and older adults. Young adults with higher perception of neighborhood social environment were more likely to perceive good health. Neighborhood built environment was significantly associated with self-rated health among middle-aged and older adults.

CONCLUSION

The neighborhood environment is an important predictor of the health of its residents. Neighborhood environmental modifications should be tailored to meet the needs of different age groups, promoting health equity.

Individual and environmental variables related to outdoor walking among older adults: Verifying a model to guide the design of interventions targeting outdoor walking

OBJECTIVE

To estimate the relationships between individual and environmental variables and outdoor walking (OW) in older adults with OW limitations through verifying a conceptual model.

METHODS

Baseline data from 205 older adults participating in a randomized trial of a park-based OW program were analyzed using structural equation modeling. We evaluated a three latent factor model: OW (accelerometry and self-report); individual factors (balance; leg strength; walking self-confidence, speed and endurance; mental health; education; income; car access); and environmental factors (neighbourhood walkability components).

RESULTS

Mean age was 75 years; 73% were women. Individual factors was significantly associated with OW (β = 0.39, p < .01). Environmental factors was not directly associated with OW but was indirectly linked to OW through its significant covariance with the individual factors (β = 0.22, p < .01). The standardized factor loadings from the individual factors on walking self-confidence and walking capacity measures exceeded 0.65.

CONCLUSIONS

Better walking capacity and more confidence in the ability to walk outdoors are associated with higher OW in older adults. Better neighbourhood walkability is indirectly associated with more OW. The conceptual model demonstrates an individual and environment association; if the capacity of the individual is increased (potentially through walking interventions), they may be able to better navigate environmental challenges.

Determinants of physical activity behavior among older adults with subjective cognitive decline based on the capability, opportunity, motivation, and behavior model: mediating and moderating effects

Background

PA is vital for secondary prevention in older adults with subjective cognitive decline (SCD), but their physical activity (PA) levels are low, and the underlying interaction pathways among associated factors are poorly understood. This study aims to identify mediating and moderating effects of determinants on PA behavior in older adults with SCD using the capability, opportunity, motivation, and behavior model.

Methods

Following the STROBE checklist, we conducted a cross-sectional survey among 289 older adults with SCD. Path regression, mediation effects, and moderation effects were used to explore the associated factors of PA behavior and the associations among these variables.

Results

The prevalence of physical inactivity among older adults with SCD was high (40.3%). The path model fit indices were χ2/df = 1.145, GFI = 0.968, CFI = 0.988, and RMSEA = 0.022. Path regression revealed that frailty, physical and social support, PA motivation, and fall history had significant direct association with PA behavior. PA motivation not only partially mediates between frailty and PA behavior but also partially mediates between physical and social support and PA behavior. Additionally, fall history moderated the relationship between frailty and PA behavior.

Conclusion

PA behavior in older adults with SCD requires improvement. Healthcare professionals should devise more effective interventions to boost PA behavior by enhancing motivation. Screening for frailty and addressing fall history, while providing sufficient physical and social support, is crucial.

Residential greenness for mitigating impacts of extreme heat events on depression and supporting mental health

Background

Residential green spaces (RGS) are a crucial aspect of urban life, which provide residents with a positive living environment both for mental and physical well-being. However, extreme heat events caused by global warming and local urban heat island effects are threatening the public health of rapidly growing populations. This is especially true for mental health. Depression is a mental illness that can be impacted by extreme heat events, i.e., heatwaves.

Objective

This study aimed to investigate the potential for residential green spaces (RGS) to alleviate depression by reducing heat stress sensitivity during extreme heat events.

Methods

We conducted a literature review using scientometric analysis with CiteSpace to summarize existing research on the relationships between RGS, depression, and heatwaves. We proposed a conceptual framework for the relationship between RGS and depression, and that extreme heat events may be an important contributor to depression.

Results

Our review found that RGS can provide ecosystem services that lower ambient temperatures through evaporative cooling, radiation reflection, humidity regulation, and shading. Different types of RGS, i.e., small green spaces, green roofs, green walls, and street trees, have varying cooling capacities. The mechanisms by which RGS alleviate depression during heatwaves involve green space composition, exposure, physical activity, social contacts, and cohesion. And we proposed a conceptual framework for the relationship between RGS and depression, and that extreme heat events may be an important contributor to depression.

Conclusion

We present a multidimensional RGS evaluation roadmap to inform green space design for reducing depression during heatwaves. Establishing RGS multidimensional evaluation can guide future research on leveraging RGS to build resilience against extreme heat and improve public mental health.

The role of physical activity in the relationship between exposure to community violence and mental health: A systematic review

Community violence is a global public health problem that is associated with mental health disorders. Physical activity can enhance mental health and may play an important role in the relationship between exposure to community violence and mental health. We systematically reviewed the literature to better understand the potential role of physical activity in this relationship. In this review, we searched the databases PubMed, Embase, Web of Science, Cochrane Central, PsycInfo, and SPORTdiscus, and conducted a grey literature search of one clinical trials registry and four organizations' websites. The review included quantitative observational studies, intervention studies, and qualitative studies published by November 30, 2022 and that involved generally healthy individuals across the lifespan. Eligible studies included measures of community violence, mental health, and physical activity. Five studies met the inclusion criteria for the review. Four studies were conducted in high-income countries, only two minority populations were represented in the studies, and none of the studies included older adults or children. Studies defined and measured community violence, mental health, and physical activity in different ways. In most studies, physical activity was not a primary focus but assessed as one item within a larger construct. The role of physical activity was examined differently across the studies and only one study found a significant role (mediator) of physical activity. This review revealed that few studies have specifically examined physical activity's role in the relationship between exposure to community violence and mental health. Further research is needed involving low-income countries, diverse minority populations, and children.

Active Aging and Smart Public Parks

The global population is aging, with the percentage of people over 60 expected to rise from 12% to 22% and 33% residing in developed countries. However, most cities lack the appropriate infrastructure to support aging citizens in active aging and traversing the urban landscape, negatively impacting their quality of life. Studies have shown that public parks and green spaces can contribute to a higher quality of life and wellbeing. Also, smart cities are intended to improve the wellbeing and health of their inhabitants. However, most solutions are typically implemented indoors and tend to overlook the needs of older adults. A smart city should consider the increasing rate of aging and give more importance to outdoor environments as a key aspect of quality of life. The article's main purpose is to provide a comprehensive background to understand the current knowledge on smart public parks and highlight the significance of new research in the field to promote active aging. The article is expected to inspire new research ideas by identifying gaps in knowledge. Open and challenging issues in emerging smart park solutions are proposed for further work.

Development and reliability testing of an audit toolbox for the assessment of the physical activity friendliness of urban and rural environments in Germany

Background

According to socio-ecological theories, physical activity behaviors are linked to the physical and social neighborhood environment. Reliable and contextually adapted instruments are needed to assess environmental characteristics related to physical activity. This work aims to develop an audit toolbox adapted to the German context, to urban and rural settings, for different population groups, and different types of physical activity; and to evaluate its inter-rater reliability.

Methods

We conducted a systematic literature search to collect existing audit tools and to identify the latest evidence of environmental factors influencing physical activity in general, as well as in German populations. The results guided the construction of a category system for the toolbox. Items were assigned to the categories based on their relevance to physical activity and to the German context as well as their comprehensibility. We piloted the toolbox in different urban and rural areas (100 street segments, 15 parks, and 21 playgrounds) and calculated inter-rater reliability by Cohen's Kappa.

Results

The audit toolbox comprises a basic streetscape audit with seven categories (land use and destinations, traffic safety, pedestrian infrastructure, cycling infrastructure, attractiveness, social environment, and subjective assessment), as well as supplementary tools for children and adolescents, seniors and people with impaired mobility, parks and public open spaces, playgrounds, and rural areas. 76 % of all included items had moderate, substantial, or almost perfect inter-rater reliability (κ > 0.4).

Conclusions

The audit toolbox is an innovative and reliable instrument for the assessment of the physical activity friendliness of urban and rural environments in Germany.

The Influence of Social Support on Leisure-Time Physical Activity of the Elderly in the Chinese Village of Fuwen

The purpose of this study was to examine the associations of social support factors with leisure-time physical activity (LTPA) of older people in Fuwen village. A cross-sectional study included 523 randomly selected elderly people (60+ years) whose LTPA levels were determined using the shortened version of the International Physical Activity Questionnaire (IPAQ-S). A modified version of the Physical Activity Social Support Scale (PASSS) was operated to gather perceived scores of the social support factors. A multivariate linear regression was performed to locate associations of perceived scores of social supports with leisure-time walking (LTW) and moderate and vigorous physical activity (MVPA). The results indicated that social support from family was positively and significantly related to LTW and MVPA in both models. The community factor was positively and significantly correlated with MVPA in both models. The sport club factor was related to LTW and MVPA to some extent. The results suggest that social support from family is the most important motivator for older people's LTW and MVPA in the village of Fuwen. Social support from the community is the motivator for older people's MVPA. The sport club factor has some effects on older people's LTW and MVPA as well. More future studies are needed to extend the database of the relationship between social support and rural older people's physical activity.

Physical Activity Level and Specific Type of Exercises Among US Middle-Aged and Older Adults: Findings From the Behavioral Risk Factor Surveillance Survey

BACKGROUND

This study aimed to assess physical activity level and identify specific types of exercises by sex, race/ethnicity, and age for adults 50 years and older.

METHODS

Behavioral Risk Factor Surveillance System 2013, 2015, and 2017 data were used to study US adults 50 years and older on their specific types of exercises, stratified by sex, race/ethnicity, and age. Weighted logistic regression was used to model physical exercise level and specific types of exercises.

RESULTS

The sample included 460,780 respondents. Non-Hispanic Black and Hispanic were less likely than non-Hispanic White to meet the recommended physical activity level (Odds ratio [OR] = 0.73, P < .0001 and OR = 0.96, P = .04, respectively). Walking was the most participated type of exercise, followed by gardening, for both men and women, all racial/ethnic groups, and all age groups. Non-Hispanic Blacks were more likely to participate in walking (OR = 1.19, P = .02) and less likely to participate in gardening (OR = 0.65, P < .0001) than non-Hispanic Whites. Men were more likely to engage in strenuous exercises than women. The average number of minutes on walking was the longest among all types of specific exercises.

CONCLUSIONS

The types of exercises were mostly walking and gardening for adults aged 50 and older. Non-Hispanic Black adults had less physical activity than non-Hispanic White and were less likely to engage in gardening.

An Umbrella Review of the Best and Most Up-to-Date Evidence on the Built Environment and Physical Activity in Older Adults ≥60 Years

Objectives: To present the best and most up-to-date evidence on associations between built environment (BE) attributes and overall and specific domains of physical activity (PA) (i.e., leisure, transport, walking, and cycling) in older adults (≥60 years).

Methods: An umbrella review was undertaken to compile evidence from systematic reviews using the Joanna Briggs Institute methodology. A comprehensive search (updated 16 August 2022), inclusion/exclusion of articles via title/abstract and full-text reviews, data extraction, and critical appraisal were completed. Only reviews with a good critical appraisal score were included.

Results: Across three included systematic reviews, each BE attribute category was positively associated with ≥1 PA outcome. A larger number of significant associations with BE attributes were reported for transport walking (13/26), total walking (10/25), and total PA (9/26), compared to leisure walking (4/34) and transport cycling (3/12). Fewer associations have been examined for leisure cycling (1/2).

Conclusion: Although the causality of findings cannot be concluded due to most primary studies being cross-sectional, these best and most up-to-date findings can guide necessary future longitudinal and experimental studies for the (re)design of age-friendly communities.

Impact of the Built Environment on Residents' Health: Evidence from the China Labor Dynamics Survey in 2016

In the process of China's rapid urbanization, the health level of residents has been improved to a great extent. However, with the expansion of urban scale and spatial restructuring, a series of urban environmental problems have posed new challenges to public health. However, the impact of the built environment on residents' health is controversial, and the applicability of the conclusions based on western urban sprawl in China is not clear enough. In addition, the exploration of the impact path of the built environment on health is still not comprehensive and in-depth. Based on the China Labor Dynamics Survey (CLDS) in 2016 and relevant statistical yearbook data, this study explored the impact of the built environment at community and urban scale on residents' health and its age heterogeneity and further explored the mediating role of physical exercise, neighborhood support, and community safety. According to the research, the urban and community-built environment has significant impacts on residents' health, and the impact is significantly different at different scales. In addition, there is a significant difference in the impact of built environment factors on residents' health among populations with different life cycles. From the perspective of the impact path, greening coverage can improve residents' self-rated health by enhancing the perceived safety of living in the community. In contrast, the high community population density will not only weaken the degree of neighborhood support but also reduce the perception level of community residential safety, thus damaging residents' health. In short, from the perspective of environmental intervention, the previously mentioned results put forward possible suggestions on strengthening the construction of a healthy living environment so as to maximize the health effectiveness of cities and communities.

Older Adults' Self-Reported Physical Activity and Distance to and Land Use Around Reported Physical Exercise Destinations

Little is known about older adults' physical exercise destinations. We studied associations between physical activity (PA) level and physical exercise destinations (total number and surrounding environment) in community-dwelling 75- to 85-year-old adults living in Central Finland. Participants (N = 901) reported the amount of at least moderate-intensity PA and physical exercise destinations. Distance from home, land use, and locations of sport facilities were defined using a geographic information system. A general linear model showed that older adults with higher PA reported higher numbers of physical exercise destinations and destinations further away from home than those reporting lower PA. Binary logistic regression showed that higher PA increased the odds of reporting a distant destination identified as a sports facility and of reporting destinations located in residential, service, forest, and water body areas, respectively. Physical exercise destinations in different environments may attract older people to go out and be more physically active.

How to collaborate for health throughout the project timeline - a longitudinal study reflecting on implemented strategies in three projects for a healthy living environment

BACKGROUND

When improving the health of local and regional populations, cross-sector collaboration between different policy domains, non-governmental organisations and citizens themselves is needed. Previously, enabling factors and strategies have been identified to improve cross-sector collaboration for health. However, few longitudinal studies have been conducted to understand how the implementation of strategies for cross-sector collaboration changes throughout the collaboration process. The aim of this study is therefore to learn more about the different strategies that were implemented throughout three cross-sector collaboration projects for a healthy living environment.

METHODS

The realist evaluation approach was used to understand how the implemented strategies worked, in which context, why and with what outcomes. Project partners were asked to reflect on their implemented strategies at two different moments in the project timelines, and quarterly updates with project leaders were held. In addition two reference panels were organised for data triangulation.

RESULTS

Three key insights for successful cross-sector collaboration throughout projects for a healthy living environment were identified, namely 1. Investing in trust among the partners and faith in the project has a positive influence on continuing the collaboration throughout the project; 2. Making stakeholders actively participate throughout the project requires additional strategies after the onset of the project, and 3. Defining roles, tasks, and other prerequisites at the start of the project helps in pursuing the project over time, but needs re-examination throughout the project. These key insights were based on multiple examples of implemented strategies, linked to context, mechanisms and outcomes.

CONCLUSIONS

This study shows the different strategies that can be employed as the collaboration in projects for a healthy living environment progresses. We found that 'trust' does not merely include the relationships built between the partners, but at the onset of projects can also be based on faith in the project itself. In addition, as it can be difficult to foresee the right investments and strategies at the onset of the project, frequent reflection moments to choose fitting strategies might benefit regional partners in their cross-sector collaboration for health.

Proactive health interventions in the workplace: The role of spatial playfulness in promoting mental health

BACKGROUND

The high prevalence of mental illnesses has a serious impact on productive life and there is an urgent need to intervene using a variety of active and effective measures.

OBJECTIVE

The concept of playfulness in space is introduced into the design of work spaces oriented towards active health interventions, creating a close interaction between the body and the space through play, thus developing a positive effect on the promotion of the physical and mental health of the staff.

METHODS

With the help of the spatial order theory, the analysis of the interaction between body and space is attempted to explore the form, structure and scene of space in order to optimize the body's perception, cognition and behavior in the space, thus creating an indoor workspace model with positive intervention effects on human health.

RESULTS

Based on the idea of spatial playful participation in active health interventions, this study explores the interaction between the body and the architectural space to enhance the perception and cognitive guidance of the space for the individual and to have a pleasant spiritual experience in the interaction to relieve work stress and enhance mental health.

CONCLUSION

This series of discussions on the relationship between architectural space and the human body is of great relevance in improving the public health of occupational groups.

Association between neighborhood physical characteristics and mental health among older adults in Spain

The aim was to assess the impact of neighborhood physical environment on mental health among non-institutionalized older adults. A cross-sectional analysis was conducted over a representative sample of 5,071 people ≥65 years from the Spanish National Health Survey. The survey included nine items addressing the self-perceived degree of discomfort due to neighborhood physical problems. Participants were categorized into groups with "no problems", "some problems" (somewhat discomfort on 1-4 items) and "many problems" (somewhat discomfort on ≥5 items or very much discomfort on ≥1 item). Mental health status was assessed using the General Health Questionnaire, consisting of 12 items assessing the severity of a psychological distress over the past few weeks. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were calculated using logistic regressions. A dose-response association (p-trend<0.001) was found between living in neighborhoods with some (OR: 1.41; 95% CI: 1.14-1.75) or many problems (OR: 1.93; 95% CI: 1.55-2.42) affecting the physical environment with poor mental health of community dwelling older adults. Integrating and articulating health considerations into public policymaking regarding housing and the residential environment can have broad implications for healthy aging.

Aging in Rural Communities

Purpose of Review

Population aging is occurring worldwide, particularly in developed countries such as the United States (US). However, in the US, the population is aging more rapidly in rural areas than in urban areas. Healthy aging in rural areas presents unique challenges. Understanding and addressing those challenges is essential to ensure healthy aging and promote health equity across the lifespan and all geographies. This review aims to present findings and evaluate recent literature (2019-2022) on rural aging and highlight future directions and opportunities to improve population health in rural communities.

Recent Findings

The review first addresses several methodological considerations in measuring rurality, including the choice of measure used, the composition of each measure, and the limitations and drawbacks of each measure. Next, the review considers important concepts and context when describing what it means to be rural, including social, cultural, economic, and environmental conditions. The review assesses several key epidemiologic studies addressing rural-urban differences in population health among older adults. Health and social services in rural areas are then discussed in the context of healthy aging in rural areas. Racial and ethnic minorities, indigenous peoples, and informal caregivers are considered as special populations in the discussion of rural older adults and healthy aging. Lastly, the review provides evidence to support critical longitudinal, place-based research to promote healthy aging across the rural-urban divide is highlighted.

Summary

Policies, programs, and interventions to reduce rural-urban differences in population health and to promote health equity and healthy aging necessitate a context-specific approach. Considering the cultural context and root causes of rural-urban differences in population health and healthy aging is essential to support the real-world effectiveness of such programs, policies, and interventions.

The impact of interventions in the built environment on physical activity levels: a systematic umbrella review

Physical activity is good for people's health. The relationship between the built environment and physical activity has been well documented. However, evidence is both scarce and scattered on specific urban interventions, i.e., intentional redesigns of the built environment that promote physical activity accompanied by pre- and post-effect measurement. This umbrella review aims to synthesize the findings of systematic reviews focused on these urban interventions. We followed the PRISMA 2020 and JBI umbrella review protocol guidelines and searched seven databases covering the period between Jan 2010 and April 2022 using keywords relating to the built environment, health, physical activity, and interventions. This yielded seven systematic reviews, in which we identified several urban interventions that can promote physical activity. We found positive effects of urban interventions on physical activity regarding park renovations, adding exercise equipment, introducing a (new) pocket park, improving cycling environments, improving walking & cycling environments, as well as multi-component initiatives for active travel and enhancing the availability & accessibility of destinations. The findings suggest that the urban environment can effectively promote physical activity, especially by adding various facilities and destinations and by making the environment better suitable for active use.

The Relationship of Neighborhood Walking Behavior to Duration of Aging in Place-A Retrospective Cohort Study

The benefits of physical activity on health are widely known. However, the impact of physical activity on aging-in-place at home for older adults is unclear. Focusing on older adults who recently moved from home to a senior-living facility, this research explored the impact of walking on the ability to age-in-place. Data were collected through a questionnaire survey completed by residents in 12 assisted-living facilities in Houston, Texas. Controlling for significant personal factors, ANOVAs were applied. Non-Hispanic White older adults (N = 124) who used canes or no aids and engaged in 30 min to 1 h of walking per occurrence were able to remain in their homes for an average of 17.84 years after age 65, 1.85 years longer than their counterparts who walked less than 30 min per occurrence. Those who walked for more than an hour per occurrence remained at home for 22.71 years on average, 6.72 years longer than their counterparts (p ≤ 0.05). Engaging in neighborhood walking may help older adults maintain more years of aging-in-place at home. The findings have a direct impact on both public health programs and community design and planning strategies promoting aging-in-place.

Neighbourhood walkability and mental health in older adults: A cross-sectional analysis from EpiFloripa Aging Study

This study aims to analyse the association between walkability index and depressive symptoms and cognitive impairment and test the mediating role of moderate-vigorous physical activity (MVPA) in this relationship among older adults from Florianópolis, Brazil. This is cross-sectional research with data from the third wave of the EpiFloripa Aging cohort study, conducted in 2017–2019. Depressive symptoms were assessed using the short version of the Geriatric Depression Scale (GDS), and cognitive impairment, using the Mini-Mental State Examination (MMSE) scales. The neighbourhood environment was assessed using a walkability index, which considered 500-m network buffers around the participants’ homes. Binary logistic regression analysis the association between the walkability index (quartile) and mental health outcomes (yes vs. no). Structural equation modelling evaluated the mediation between the walkability index and cognitive impairment by MVPA with an estimator of dichotomous variables. 1,162 people participated in the study (61.5% women, average age = 73.1). Older adults residing in places with a high and highest walkability index were 38% and 44% less likely to have cognitive impairment, respective. There was no association between depressive symptoms and walkability index in crude nor adjusted analysis. Engaging in MVPA had a partial but not significant effect (14%; p = 0.087), showing a tendency for this relationship to be partially explained by the greater engagement in physical activities in places with greater walkability. Policy planning to prevent and reduce the risks of cognitive impairment should consider factors of the physical environment as determinants in older adults.

Environmental Factors in the Rehabilitation Framework: Role of the One Health Approach to Improve the Complex Management of Disability

Environment factors play a crucial implication in human health, with strong evidence suggesting that several biological, chemical, physical and social factors could be possible targets to implement effective strategies for human health promotion. On the other hand, a large gap of knowledge still exists about the implications of environmental factors in terms of functional impairment and disability, while the integration of an environmental-based approach in the therapeutic care of patients affected by disabilities remains still challenging. In this scenario, the One Health approach has been recently introduced in clinical care and aims to optimize health outcomes by recognizing the interconnection between people and the environment. Concurrently, the "Rehabilitation 2030 Initiative" proposed in 2017 by the WHO emphasized the need to integrate environmental-based strategies to promote rehabilitation across different health systems and different nations. However, no previous study underlined the potential implications of the One Health approach in the rehabilitation setting, nor the role of a comprehensive rehabilitation approach focused on environmental factors. Therefore, the aim of this narrative review was to present a comprehensive overview of the data currently available assessing the close relationship between rehabilitation and the environment to provide a different perspective on the comprehensive care of patients affected by disability.

Built Environments and Cardiovascular Health: REVIEW AND IMPLICATIONS

PURPOSE

This review presents a general overview of the state of evidence on the relationships between neighborhood built environments and cardiovascular health outcomes among adults. We also summarize relevant literature on the associations of built environments with active living behaviors (physical activity [PA] and sedentary behavior), as they are considered as key behavioral pathways.

REVIEW METHODS

We identified recently published systematic reviews assessing associations of built environment attributes with cardiovascular health outcomes or active living behaviors. We summarized findings of the key systematic reviews and presented findings of pertinent empirical studies, where appropriate.

SUMMARY

Increasing evidence suggests that living in a place supportive of engaging in PA for transportation (eg, walkability features) and recreation (eg, parks) can be protective against cardiovascular disease (CVD) risk. Places conducive to higher levels of sedentary travel (ie, prolonged sitting in cars) may have adverse effects on cardiovascular health. The built environment of where people live can affect how active they are and subsequently their cardiovascular health. Clinical professionals are encouraged to consider the built environment features of where their patients live in counseling, as this may assist them to understand potential opportunities or barriers to active living and to propose a suitable CVD prevention strategy.

A hierarchy of correlates for objectively measured physical activity, sedentary time, and physical fitness in older adults: A CHAID analysis

The aging process reflects, in many cases, not only a decline in physical activity (PA) and physical fitness (PF), but also an increase in overall levels of sedentary time (ST). In order to hierarchically identify the most powerful correlates related to low and high levels of objectively assessed PA, ST, and PF during the late adulthood, a total of 2666 older adults were cross-sectionally evaluated. Multidimensional correlates were obtained through interview. Using chi-squared automatic detection analysis to identify the cluster of correlates with most impact on PA (<21.4 min/day), ST (≥8 h/day), and PF (<33.3th percentile), was found that the most likely subgroup to be physically inactive consisted of widowers not owning a computer and sport facilities in the neighbourhood (94.7%), while not being widowed, reporting to have a family that exercises and a computer at home (54.3%) represented the subgroup less likely to be inactive. Widowers without sidewalks in the neighbourhood were the most sedentary group (91.0%), while being a married woman and reporting to have space to exercise at home (40%) formed the most favourable group of correlates regarding ST. Men reporting a financial income <500€ and physical problems frequently formed the group with the lowest PF level (70.3%). In contrast, the less likely subgroup to have low levels of PF level consisted of having a financial income ≥1000€ and a computer at home (3.4%). Future interventions should target widowers with limited accessibility to computer and urban/sport-related infrastructures, as well as impaired older adults with low financial income.HighlightsChi-squared automatic interaction detection was used to identify and hierarchise correlates of objectively measured physical activity, sedentary time, and fitness.Widowers not having a computer at home and sport facilities in the neighbourhood were the most likely to be physically inactive, while not being widowed, having a family that exercises and a computer at home represented the subgroup less likely to be physically inactive.The most likely to be classified as sedentary were widowers without sidewalks in the neighbourhood, while the most favourable group of correlates regarding ST was formed by married women and reporting to have space to exercise at home.Individuals with a low financial income and physical problems comprised the population subgroup with the lowest PF levels, while having a medium-high financial income and a computer at home represented the less likely subgroup to have low levels of PF.

Characteristics of Physical Activities and Environmental Factor Preferences of Older Adults in Rural Resettlement Community in Ningbo, China

As physical mobility declines, older adults become increasingly dependent on their living environment. The relationship between physical activities and community environments for older adults has been studied to help promote physical and mental health and increase social connections among older adults, thereby improving their quality of life and health status. This study analyzed the daily outdoor physical activities of older adults in Nanyu New Village, China, using behavior mapping and questionnaire research for data collection, and conducting a comprehensive analysis of the spatial, temporal, and environmental elements of the physical activities. This research showed that the physical activity choices of older adults in rural resettlement neighborhoods vary significantly by time, gender, and space. In decreasing order, surrounding support, site security, space convenience, beautiful landscape, and diverse facilities influence the outdoor physical activities of older adults. This study provides new insights into the ongoing debate on age-friendly communities and provides a useful reference for the design of age-friendly retrofitting of outdoor environments in rural resettlement communities.

Parameters of the Infrastructure of the Residential Area and Their Relationship with Cardiovascular Risk Factors

Aim. This study determined the level of public satisfaction with neighborhood design features in Kemerovo Oblast and their connection to cardiovascular disease risk factors.

Subjects and methods. The study population included 1,598 respondents aged between 35 and 70, with 491 living in rural areas and others living in Kemerovo (1,221 women and 477 men). The assessment of neighborhood environment was done according to residents' subjective opinions about infrastructural features (the Neighborhood Environmental Walkability Scale). Depending on how participants responded to the questionnaire, some of these parameters were identified as adverse.

Results. The residents of Kemerovo and rural areas of Kemerovo Oblast identified the following neighborhood design features as adverse: the lack of interesting places in neighborhood environment, the remote location of parks and restaurants, the absence of pavement, busy traffic, and a long distance between home and workplace. In the city, arterial hypertension prevalence was high among men, when grocery, fruit and clothing stores were distant, and among women, when banks, public transport stops were distant and the traffic was heavy. Lipid metabolism disorders were more common among women in urban areas, when there were no interesting places around. Obesity prevalence was high among urban female population, when the following adverse factors were present: the remote location of grocery stores, fruit stores, bank, pharmacy and public transport stops and the absence of pavement. Among rural male population, this risk factor was common when there were no pavements. The highest rate of carbohydrate metabolism disorders was found among women living in villages where the traffic is heavy and public transport stops are far away.

Conclusion. The impact of infrastructure on the health status of the living population is a new direction of scientific research. Epidemiological studies in different geographic areas and population groups show significant differences in health status, morbidity and mortality from chronic noncommunicable diseases. To reduce the risks of developing diseases of the cardiovascular system, the formation of a socially comfortable health-saving environment is of great importance.

The neighbourhood environment and profiles of the metabolic syndrome

BACKGROUND

There is a dearth of studies on how neighbourhood environmental attributes relate to the metabolic syndrome (MetS) and profiles of MetS components. We examined the associations of interrelated aspects of the neighbourhood environment, including air pollution, with MetS status and profiles of MetS components.

METHODS

We used socio-demographic and MetS-related data from 3681 urban adults who participated in the 3rd wave of the Australian Diabetes, Obesity and Lifestyle Study. Neighbourhood environmental attributes included area socio-economic status (SES), population density, street intersection density, non-commercial land use mix, percentages of commercial land, parkland and blue space. Annual average concentrations of NO₂ and PM_2.5 were estimated using satellite-based land-use regression models. Latent class analysis (LCA) identified homogenous groups (latent classes) of participants based on MetS components data. Participants were then classified into five metabolic profiles according to their MetS-components latent class and MetS status. Generalised additive mixed models were used to estimate relationships of environmental attributes with MetS status and metabolic profiles.

RESULTS

LCA yielded three latent classes, one including only participants without MetS ("Lower probability of MetS components" profile). The other two classes/profiles, consisting of participants with and without MetS, were "Medium-to-high probability of high fasting blood glucose, waist circumference and blood pressure" and "Higher probability of MetS components". Area SES was the only significant predictor of MetS status: participants from high SES areas were less likely to have MetS. Area SES, percentage of commercial land and NO₂ were associated with the odds of membership to healthier metabolic profiles without MetS, while annual average concentration of PM_2.5 was associated with unhealthier metabolic profiles with MetS.

CONCLUSIONS

This study supports the utility of operationalising MetS as a combination of latent classes of MetS components and MetS status in studies of environmental correlates. Higher socio-economic advantage, good access to commercial services and low air pollution levels appear to independently contribute to different facets of metabolic health. Future research needs to consider conducting longitudinal studies using fine-grained environmental measures that more accurately characterise the neighbourhood environment in relation to behaviours or other mechanisms related to MetS and its components.

Traffic as a Barrier to Walking Safely in the United States: Perceived Reasons and Potential Mitigation Strategies

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Almost a quarter of US adults perceive traffic as a barrier to safe walking.

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Vehicle speed is the leading perceived traffic characteristic of concern.

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Respondents perceive sidewalks as the most favorable strategy to mitigate risk.

Motor vehicle traffic is commonly cited as a barrier to walking, but national level perceptions of traffic characteristics that negatively influence walking and potential traffic mitigation strategies remain unclear. The objectives of this study were to describe perceptions of (1) traffic characteristics that make walking unsafe in the United States and (2) potential mitigation strategies to address these concerns among those who report traffic as a barrier to walking. Data were from FallStyles, a nationwide internet panel survey conducted in October 2019 (n = 3,284 adults). Respondents reported if traffic makes walking unsafe where they live; those who answered yes were then asked about traffic characteristics that make walking unsafe (number of vehicles, speed of vehicles, distracted or impaired driving, types of vehicles, and other reasons) and potential mitigation strategies (new or improved sidewalks, crosswalks, pedestrian signals, street lighting, things that slow vehicles down, separating the sidewalk from the road, fewer vehicle lanes, and other). Prevalence of responses was assessed overall and by select sociodemographic and geographic characteristics, and by walking status. Nearly 25% of US adults reported that traffic is a barrier to walking where they live. Of these, 79% selected vehicle speed as a contributing traffic characteristic, and 57% indicated new or improved sidewalks as a potential mitigation strategy. These top responses were shared across all sociodemographic, geographic, and walking behavior subgroups. Speed reduction efforts and built environment enhancements such as sidewalks may alleviate pedestrian safety concerns. Promotion campaigns may be needed to bring awareness to such changes.

The Relationship Between Built Environment and Mental Health of Older Adults: Mediating Effects of Perceptions of Community Cohesion and Community Safety and the Moderating Effect of Income

Many studies revealed a significant correlation between low-density built environment and the mental health of older adults in developed countries. However, scholars and decision-makers recently began to pay close attention to the effect of this relationship in high-density built environments and in developing countries. Using point-of-interest (POI) data from Baidu and data on 20 communities in Guangzhou, China, which were collected through a questionnaire survey, this study aimed to examine the relationship between built environment and the mental health of older adults as well as the physiological–psychological mediating paths between the two, so as to enrich the research on population aging in the high-density urban context in developing countries. The findings indicated that facility accessibility and distance to parks significantly positively correlated with the mental health of older adults and the number of public transit stations, and the distance to these stations significantly negatively correlated with the mental health of older adults. Also, the perceptions of community cohesion and community safety had a significant mediating effect between the built environment and the mental health of older adults. Furthermore, the moderating effect analysis results verified the moderating effect of income: with an increase in income, the perception of community cohesion enhanced the protection of the mental health of older adults and reduced the mediating effect of the perception of community safety. The results provided a reference for policy-makers and urban planners in their efforts to plan and build health-supporting communities and a healthy aging society.

Methodological approaches for assessing certainty of the evidence in umbrella reviews: A scoping review

Introduction

The number of umbrella reviews (URs) that compiled systematic reviews and meta-analysis (SR-MAs) has increased dramatically over recent years. No formal guidance for assessing the certainty of evidence in URs of meta-analyses exists nowadays. URs of non-interventional studies help establish evidence linking exposure to certain health outcomes in a population. This study aims to identify and describe the methodological approaches for assessing the certainty of the evidence in published URs of non-interventions.

Methods

We searched from 3 databases including PubMed, Embase, and The Cochrane Library from May 2010 to September 2021. We included URs that included SR-MAs of studies with non-interventions. Two independent reviewers screened and extracted data. We compared URs characteristics stratified by publication year, journal ranking, journal impact factor using Chi-square test.

Results

Ninety-nine URs have been included. Most were SR-MAs of observational studies evaluating association of non-modifiable risk factors with some outcomes. Only half (56.6%) of the included URs assessed the certainty of the evidence. The most frequently used criteria is credibility assessment (80.4%), followed by GRADE approach (14.3%). URs published in journals with higher journal impact factor assessed certainty of evidence than URs published in lower impact group (77.1 versus 37.2% respectively, p < 0.05). However, criteria for credibility assessment used in four of the seven URs that were published in top ranking journals were slightly varied.

Conclusions

Half of URs of MAs of non-interventional studies have assessed the certainty of the evidence, in which criteria for credibility assessment was the commonly used method. Guidance and standards are required to ensure the methodological rigor and consistency of certainty of evidence assessment for URs.

Identifying Strategies for Facilitating Physical Activity Among Older Adults: A Behaviour Change Wheel 'Retrofit' Driven Analysis of Victorian Local Government Policy

ISSUE ADDRESSED

The significance of physical activity (PA) for the health and wellbeing of older adults is well documented. Local government (LG) publish PA policy and interventions to encourage and improve older adult PA participation. However, LG documents have rarely been studied to examine the extent to which LG incorporates evidence-based strategies into the development of older adult PA policy.

METHODS

The Behaviour Change Wheel (BCW) 'retrofitting' approach was used to identify and explain available evidence-based PA policies and interventions across 10 Victorian LGs. A document analysis was completed using LG policy and involved elements of content analysis and thematic analysis.

RESULTS

The analysis found 41 documents that included policy and interventions to encourage and improve PA among older adults. Some of the more popular BCW combinations included service provision and enablement and environmental/ social planning, and environmental restructuring. In addition, LGs embrace modifying the built environment and creating partnerships. However, our results suggest that some are not considering modelling or incentives to increase PA.

CONCLUSIONS

According to the BCWs, Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity (APEASE) criteria, it is not feasible for Victorian LGs to be including all intervention functions and supporting policy functions. However, contemporary older adult PA intervention literature suggests LGs could benefit from including incentives and modelling into current PA policy. SO WHAT?: This research is one of the first to identify and explain how Victorian LGs facilitate PA participation among older adults. This research will guide Victorian LGs when drafting and implementing PA policy in the future.

Older people and nature: the benefits of outdoors, parks and nature in light of COVID-19 and beyond- where to from here?

The COVID-19 pandemic has taken a significant toll on people's health and wellbeing globally. In the pandemic, parks, gardens and other local green spaces have been recognised as vital to people's physical and mental health. Emerging global evidence shows increased access to local parks and recreational activities and a new appreciation of the natural surroundings. Various movements and organisations globally have called for actions to embrace recent trends and changes in relation to the planning of public spaces and urban built environments to enable better access to parks and nature. The crisis, however, has exposed the inequities around access to green space where vulnerable populations such as older people and those in low socioeconomic areas are particularly affected. The crisis presents an opportunity to positively impact on society, and an opportunity to consolidate new emerging trends to better integrate nature into the architecture, infrastructure, and public spaces of urban areas.

The Effect of Built Environment on Older People Leisure-Time Walking and Physical Activity in Different Sex Groups in the City of Ningbo, China

The aim of this study was to examine the effect of built environment (BE) elements on older people’s (OP) leisure-time physical activity (LTPA) and leisure-time walking (LTW) level in the city of Ningbo. Older participants numbering 312 were randomly recruited using cross-sectional survey in 2019. International Physical Activity Questionnaire-short version (IPAQ-S) and Neighborhood Environment Walkability Scale—abbreviated (NEWS-A)—were used to gather LTPA data and the perceive scores of BE, respectively. Liner regression analysis was performed to investigate the association relationship between the perceived scores of BE and OP’s LTW and LTPA. The study’s results showed that, when not considering different sex groups, OP’s LTW was significantly related with the perceived scores of access to services (AE, p = 0.045), walking/cycling facilities (W/CF, p = 0.007), aesthetics, and land use mix diversity (LUMD, p = 0.04). OP’s LTPA was significantly related with AE (p = 0.04) and aesthetics (p < 0.001). The association relationships of BE with LTW and LTPA varied in different sex groups. Three elements (AE, W/CF, and LUMD) and one element (pedestrian/traffic safety and P/TS) of BE were found be related with older male and older female’s LTW, respectively. One element (aesthetics) and two elements (aesthetics, LUMD) of BE were found be related with older male and older female’s LTPA, respectively. The results indicated that the effects of BE on OP’s LTW and the effects of BE on OP’s LTPA were different. The effect also varied in different sex groups. More studies are needed to confirm the effect of BE on OP’s LTW and LTPA in different sex groups to globally enrich the scientific data base.

Understanding Physical Activity Differences Among Older Adults: Validating a Proposed Typology of Physical Activity as a Tool to Increase Physical Activity by Older Adults

Objective

Being physically active as one ages benefits both physical and mental health and remains a public health need. A typology to understand older adults’ PA level and intentions can be vital to developing strategies to promote PA.

Methods

The researchers developed a comprehensive interview guide and interviewed adults 50 years and older ( n=232) to test the validity of the four-type typology (1). Frail, (2). Ambivalent, (3). Aspiring, (4). Active).

Results

The Kruskal–Wallis test and the Bonferonni post hoc analysis indicated that there were significant differences between types and for each PA category measured, revealing a continuum of PA levels by type and confirmed the four types within this continuum.

Discussion

The validated typology and the associated tool can be used to identify and implement built environment improvements and interventions aimed to support PA needs of older adults.

Assessing and Qualifying Neighborhood Walkability for Older Adults: Construction and Initial Testing of a Multivariate Spatial Accessibility Model

Population aging and urban development pose major challenges for societies today. Joining the literature assessing urban accessibility, the present exploratory research developed a multivariate accessibility model based on four independent variables—related to formal and structural urban space—that influence walkability for older adults (pedestrian network; facilities and shops; public benches; and slopes and gradients). The model used ArcGIS software. For the accessibility calculations, we selected two suburban neighborhoods in the conurbation of Grenoble (France) and selected three types of older adults’ profiles to reflect the variety of aging: an older adult in good health, an older adult with a chronic disease, and an older adult with reduced mobility. The results suggest that the accessibility of a neighborhood depends not only on its physical and urban characteristics, but it is also influenced by the physical and health characteristics of its inhabitants. The originality of the model lies mainly in its ability to estimate the spatial accessibility of a territory by taking into account, firstly, objective data such as the physical characteristics and the built environment of the neighborhood through objectification variables that consider such original variables as the presence of benches or the slopes and gradients and, secondly, specific data such as the physical and/or health characteristics of the study population. The measurement of geospatial accessibility could be of great value for public health in urban contexts, which is why relevant tools and methodologies are needed to objectively examine and intervene in public spaces in order to make them age-friendly.

Age-friendly neighbourhoods and physical activity of older Surinamese individuals in Rotterdam, the Netherlands

BACKGROUND

Age-friendly neighbourhoods seem to promote physical activity among older individuals. Physical activity is especially important for chronically ill individuals. In the Netherlands, older Surinamese individuals are more likely to have chronic diseases than are their native Dutch counterparts. This study examined relationships of neighbourhood characteristics with physical activity among older Surinamese individuals in Rotterdam, the Netherlands.

METHODS

Of 2749 potential participants, 697 (25%) community-dwelling older (age ≥ 70 years) Surinamese individuals living in Rotterdam, the Netherlands, completed a questionnaire on personal and neighbourhood characteristics between March and June 2020. Correlation and multilevel regression analyses were performed to identify associations between missing neighbourhood characteristics for ageing in place and physical activity.

RESULTS

Scores for the neighbourhood domains communication and information (r = -0.099, p ≤ 0.05), community support and health services (r = -0.139, p ≤ 0.001), and respect and social inclusion (r = -0.141, p ≤ 0.001), correlated negatively with participants' PA. In the multilevel analysis, overall missing neighbourhood characteristics to age in place scores were associated negatively with physical activity (p ≤ 0.05).

CONCLUSION

This study showed the importance of age-friendly neighbourhoods for physical activity among older Surinamese individuals in Rotterdam, the Netherlands. Our findings suggest that the neighbourhood plays an important role in supporting older individuals' leading of physically active lifestyles. Further research is needed to support the development of interventions to create age-friendly neighbourhoods.

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

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

Non-Linear Effects of the Built Environment and Social Environment on Bus Use among Older Adults in China: An Application of the XGBoost Model

Global aging has raised increasing concerns on the health and well-being of older adults. Public transport is a viable option to improve the mobility and quality of life among older adults. However, policies that promote the public transport use among older adults are rare. This study utilizes the eXtreme Gradient Boosting (XGBoost) decision tree to explore the non-linear associations of the built and social environment with bus use among older adults in China. The bus use of older adults was obtained from the Zhongshan Household Travel Survey (ZHTS) in 2012. Results show that non-linear relationships exist among all built environment and social environment characteristics. Within certain thresholds, the percentage of green space land use, land use mixture, bus-stop density, and dwelling unit density are positively related to bus use among older adults. Likewise, one social environment variable, the proportion of older adults in a neighborhood, is the key social environment variable. Furthermore, the dwelling unit density and proportion of older adults appear to have an inverse U-shaped relationship. Additionally, age, ownership of motorcycles, and distance from home to the nearest bus stop also show non-linearity. The findings presented in this paper facilitate effective planning interventions to promote bus use among older adults.

Associations Between Perceived Neighborhood Walkability and Device-Based Physical Activity and Sedentary Behavior Patterns in Older Adults

Neighborhood walkability has been associated with self-reported sedentary behavior (SB) and self-reported and objective physical activity. However, self-reported measures of SB are inaccurate and can lead to biased estimates, and few studies have examined how associations differ by gender and age. The authors examined the relationships between perceived neighborhood walkability measured with the Physical Activity Neighborhood Environment Scale (scored 1.0-4.0) and device-based SB and physical activity in a cohort of community-dwelling older adults (N = 1,077). The authors fit linear regression models adjusting for device wear time, demographics, self-rated health, and accounting for probability of participation. The Higher Physical Activity Neighborhood Environment Scale was associated with higher steps (+676 steps/point on the Physical Activity Neighborhood Environment Scale, p = .001) and sit-to-stand transitions (+2.4 transitions/point, p = .018). Though not statistically significant, stratified analyses suggest an attenuation of effect for those aged 85 years and older and for women. Consistent with previous literature, neighborhood walkability was associated with more steps, though not with physical activity time. The neighborhood environment may also influence SB.

Outdoor Recreation for Older Adults in Scotland: Qualitatively Exploring the Multiplicity of Constraints to Participation

Active ageing can lead to better health outcomes in older people. Examining constraints to outdoor recreation for older people, including outdoor physical activity, may therefore assist with developing strategies for active ageing. Findings are presented from a study seeking to understand the constraints to older peoples' access to outdoor recreation in Scotland, and this paper aimed to examine the multitude of constraints that discourage or prevent older people from accessing the outdoors and the ways in which these constraints are hierarchical (or not). This paper adopted a qualitative methodology using the hierarchical leisure constraints model (HLCM) as a lens to analyse the data, presenting the data in three vignettes. The paper identified multiple co-occurring constraints and considered these in relation to expectations based on the HLCM. Recognising that constraints to outdoor recreation for older people are multiple, co-occurring and mutually reinforcing may enable more effective solutions to be developed to overcome them.

Review of Ecological Approach Factors Affecting Physical Activity among Older People

This review aimed to investigate factors affecting physical activity among older people at the individual, social, and environmental levels based on an ecological approach. We searched PubMed, EMBASE, Web of Science, Cochrane Library, and Korean databases to identify all relevant studies that examined physical activity of older people using an ecological approach. Individual factors included socio-demographic characteristics, physical function components, and subjective health perceptions. Social factors included intimate relationships and social support. Environmental factors included physical living conditions, movement-related components, and policies and programs that affect the environment. This review analyzed the factors affecting physical activity of older people in three levels based on the ecological approach. This result provides a basis for managing, preventing, and promoting physical activity in older people based on an ecological approach and highlights the importance of environmental factors for improving physical activity among older people when applying foundational data for health prevention and management.

Neighborhood Socioeconomic Resources and Crime-Related Psychosocial Hazards, Stroke Risk, and Cognition in Older Adults

Living in neighborhoods with lower incomes, lower education/occupational levels, and/or higher crime increases one’s risk of developing chronic health problems including cardiovascular disease risk factors and stroke. These cardiovascular health problems are known to contribute to cognitive decline and dementia. The purpose of this study was to determine the association of neighborhood socioeconomic resources and crime-related psychosocial hazards on stroke risk and cognition, hypothesizing that cardiovascular health would mediate any relationship between the neighborhood-level environment and cognition. The study evaluated 121 non-demented Chicago-area adults (~67 years; 40% non-Latino White) for cardiovascular health problems using the Framingham Stroke Risk Profile 10-year risk of stroke (FSRP-10). The cognitive domains that were tested included memory, executive functioning, and attention/information processing. Neighborhood socioeconomic resources were quantified at the census tract level (income, education, and occupation); crime-related psychosocial hazards were quantified at the point level. Structural equation modeling (SEM) did not show that the FSRP-10 mediated the relationship between neighborhood characteristics and domain-specific cognition. The SEM results did suggest that higher crime rates were associated with a higher FSRP-10 (β(105) = 2.38, p = 0.03) and that higher FSRP-10 is associated with reduced attention/information processing performance (β(105) = −0.04, p = 0.02) after accounting for neighborhood socioeconomic resources. Clinicians may wish to query not only individual but also neighborhood-level health when considering cognition.

Association between Urban Greenspace and Health: A Systematic Review of Literature

The current review aimed to explore the association between urban greenspaces and health indicators. In particular, our aims were to analyze the association between publicly accessible urban greenspaces exposure and two selected health outcomes (objectively measured physical activity (PA) and mental health outcomes (MH)). Two electronic databases—PubMed/Medline and Excerpta Medica dataBASE (EMBASE)—were searched from 1 January 2000 to 30 September 2020. Only articles in English were considered. Out of 356 retrieved articles, a total of 34 papers were included in our review. Of those, 15 assessed the association between urban greenspace and PA and 19 dealt with MH. Almost all the included studies found a positive association between urban greenspace and both PA and MH, while a few demonstrated a non-effect or a negative effect on MH outcomes. However, only guaranteeing access is not enough. Indeed, important elements are maintenance, renovation, closeness to residential areas, planning of interactive activities, and perceived security aspects. Overall, despite some methodological limitations of the included studies, the results have shown almost univocally that urban greenspaces harbour potentially beneficial effects on physical and mental health and well-being.

Neighborhood Age Composition and Self-Rated Health: Findings from a Nationally Representative Study

Neighborhood age composition is an understudied area. Furthermore, existing empirical and conceptual work is conflicting, with some scholarship-indicating neighborhoods with older adults are beneficial and other scholarship suggesting it can be detrimental. Combining data from 7,197 older adults from the first wave (2011) of the National Health & Aging Trends Study and census tract data from the National Neighborhood Change Database, the purposes of our study were to: 1) identify the characteristics of neighborhoods experiencing different types of changes in age composition, and 2) examine the association between neighborhood age composition and self-rated health. Findings indicate that neighborhoods experiencing Concentration (where the number of older adults are declining but their percentage of the total population are increasing), the majority of which are in urban areas, have less aggregate economic resources, more indicators of neighborhood disorder, and less access to services and supports. Regression models also suggest older adults living in Concentration neighborhoods reported lower self-rated health compared to those living in the other three neighborhood types. Findings point to the importance of considering neighborhood age composition when targeting interventions and resources, and the potential consequences of being stuck in place in a neighborhood that does not meet elders' needs.

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

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

Objectively Measured Built Environments and Cardiovascular Diseases in Middle-Aged and Older Korean Adults

This study assesses the association between the objectively measured built environment and cardiovascular diseases (CVDs) in 50,741 adults from the Korean Community Health Survey. The CVD outcomes of hypertension, diabetes, dyslipidemia, stroke, and myocardial infarction (MI) or angina were derived from self-reported histories of physician diagnoses. Using ArcGIS software and Korean government databases, this study measured the built environment variables for the 546 administrative areas of Gyeonggi province. A Bayesian spatial multilevel model was performed independently in two age groups (i.e., 40–59 years or ≥60 years). After adjusting for statistical significant individual- and community-level factors with the spatial associations, living far from public transit was associated with an increase in the odds of MI or angina in middle-aged adults, while living in neighborhoods in which fast-food restaurants were concentrated was associated with a decrease in the odds of hypertension and stroke. For adults 60 or older, living farther from public physical-activity (PA) facilities was associated with a 15% increased odds for dyslipidemia, compared with living in neighborhoods nearer to PA facilities. These findings suggest that creating a built environment that provides more opportunities to engage in PA in everyday life should be considered a strategy to reduce the prevalence of CVD.

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

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

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

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