Does the built environment influence location- and trip-based sedentary behaviors? Evidence from a GPS-based activity space approach of neighborhood effects on older adults

OBJECTIVE

Evidence on the influence of built environments on sedentary behaviors remains unclear and is often contradictory. The main limitations encompass the use of self-reported proxies of sedentary time (ST), the scarce consideration of the plurality of sedentary behaviors, and environmental exposures limited to the residential neighborhood. We investigated the relationships between GPS-based activity space measures of environmental exposures and accelerometer-based ST measured in total, at the place of residence, at all locations, and during trips.

METHODS

This study is part of the CURHA project, based on 471 older adults residing in Luxembourg, who wore a GPS receiver and a tri-axial accelerometer during 7 days. Daily ST was computed in total, at the residence, at all locations and during trips. Environmental exposures included exposure to green spaces, walking, biking, and motorized transportation infrastructures. Associations between environments and ST were examined using linear and negative binomial mixed models, adjusted for demographics, self-rated health, residential self-selection, weather conditions and wear time.

RESULTS

Participants accumulated, on average, 8 h and 14 min of ST per day excluding sleep time. ST spent at locations accounted for 83 % of the total ST. ST spent at the residence accounted for 87 % of the location-based ST and 71 % of the total ST. Trip-based ST represents 13 % of total ST, and 4 % remained unclassified. Higher street connectivity was negatively associated with total ST, while the density of parking areas correlated positively with total and location-based ST. Stronger associations were observed for sedentary bouts (uninterrupted ST over 20 and 30 min).

CONCLUSION

Improving street connectivity and controlling the construction of new parking, while avoiding the spatial segregation of populations with limited access to public transport, may contribute to limit ST. Such urban planning interventions may be especially efficient in limiting the harmful uninterrupted bouts of ST among older adults.

Does work-related and commuting physical activity predict changes in physical activity and sedentary behavior during the transition to retirement? GPS and accelerometer study

We examined how GPS and accelerometer measured work-related and commuting physical activity contribute to changes in physical activity and sedentary behavior during the retirement transition in the Finnish Retirement and Aging study (n = 118). Lower work-related activity was associated with a decrease in sedentary time and an increase in light physical activity during retirement. Conversely, higher work-related activity was associated with an increase in sedentary time and a decrease in light physical activity, except among those active workers who also were active commuters. Thus, both work-related and commuting physical activity predict changes in physical activity and sedentary behavior when retiring.

Physical activity change across retirement by device measured work-related and commuting activity

Background

Work-related and commuting physical activity before retirement may contribute to changes in physical activity and sedentary time after retirement, and the aim of this study was to examine these associations.

Methods

Study population consisted of participants of the Finnish Retirement and Aging study (n = 119). Activity behaviour was measured with GPS and accelerometer devices. The participants provided 637 measurement days before and 557 days after retirement. Work-related physical activity was defined as physical activity accumulated at workplace. Commuting activity was dichotomised based on the speed of trips between home and workplace to active (<20 km/h) and passive (≥20 km/h) commute. Participants were divided into four groups: non-active workers and commuters, non-active workers but active commuters, active workers but non-active commuters, and active workers and commuters. Linear regression analysis with generalized estimating equations were used for statistical analysis.

Results

The change in physical activity during retirement transition markedly varied by the activity group. Lower work-related activity was associated with an increase in light physical activity and a decrease in sedentary time. Conversely, higher work-related activity was associated with a decrease in light physical activity and an increase in sedentary time, except among those active workers who were active commuters. Particularly the active workers but non-active commuters increased their sedentary time (48 min, 95% Cl 20 to 76) and decreased their light physical activity (54 min, 95% Cl -80 to -29). No statistically significant changes in moderate-to-vigorous physical activity were observed.

Conclusions

Our results suggest that work-related physical activity is associated with changes in physical activity behavior when retiring. Special attention should be targeted to active workers who are non-active commuters to maintain physical activity and decrease sedentary time after retirement.

Key messages

Changes in physical activity by context and residential greenness among recent retirees: Longitudinal GPS and accelerometer study

This study examined the changes in accelerometer-measured physical activity by GPS-measured contexts among Finnish retirees (n = 45 (537 measurement days)) participating in a physical activity intervention. We also assessed whether residential greenness, measured with Normalized Difference Vegetation Index, moderated the changes. Moderate-to-vigorous physical activity (MVPA) increased at home by 7 min/day, (P < 0.001) and during active travel by 5 min/day (P = 0.03). The participants with the highest vs. lowest greenness had 25 min/day greater increase in MVPA over the follow-up (P for Time*Greenness interaction = 0.04). In conclusion, retirees participating in the intervention increased their MVPA both at home and in active travel, and more so if they lived in a greener area.

Spatial distribution of gambling: two indexes in support of the reduction of health inequalities

Background

Many studies have showed that disadvantaged areas residents have greater access to gambling sites and are more affected by gambling. Our research proposes an innovative method to characterize gambling environments in Quebec and addresses social inequality with respect to gambling exposure.

Methods

This cross-sectional ecological study was carried out in 3 stages: a Gambling Exposure Index (GEI) was built and is composed of 3 dimensions: spatial accessibility to gambling sites, density of gambling places, and relative risk associated with the types of game. The two-step floating catchment area (2SFCA) method was used to combine these dimensions into an overall GEI index. Data was retrieved from a geocoded directory of gambling sites and commercial databases. The relative risk of games is expressed by prevalence rates for those specific games in a Quebec population prevalence survey. A Vulnerability to Gambling Index (VGI) was produced based on 6 socio-economic proxies of problem gambling from the 2016 Canadian census, which were weighted and aggregated at the dissemination area (DA) level. Spatial and descriptive statistical analyses were conducted to explore the relationship between VGI and GEI, and to identify highly exposed and vulnerable areas.

Results

Our analyzes reveal significant associations between the GEI and the VGI in 2 599 out of 13 420 Quebec DAs (p &lt; 0.05). Sectors with a high GEI show an average distance to the closest gambling sites of 2.8 km compared with 13.5 km for more advantaged sectors.

Conclusions

The interactive online mapping of the two indexes and statistical analysis of the results are beneficial to the professionals working in several fields such as risk monitoring, management of zoning, licensing and gambling distribution, prevention and treatment services. The method and the associated tools can be adapted to address the problem of increased accessibility to other unhealthy products in vulnerable neighborhoods.

Key messages

Two innovative ecological indexes show that increased accessibility to gambling correlates with a higher vulnerability to gambling in many Quebec regions. The online interactive map on gambling exposure and vulnerability provides reliable criteria to municipal, regional and governmental bodies for a safer distribution of gambling offer.

Place and health in diabetes: the neighbourhood environment and risk of depression in adults with type 2 diabetes

BACKGROUND

Depression is a common co-illness in people with diabetes. Evidence suggests that the neighbourhood environment impacts the risk of depression, but few studies have investigated this effect in those with diabetes. We examined the effect of a range of neighbourhood characteristics on depression in people with Type 2 diabetes.

METHODS

This cohort study used five waves of data from 1298 participants with Type 2 diabetes from the Diabetes Health Study (2008-2013). We assessed depression using the Patient Health Questionnaire. We measured neighbourhood deprivation using census data; density of services using geospatial data; level of greenness using satellite imagery; and perceived neighbourhood characteristics using survey data. The effect of neighbourhood factors on risk of depression was estimated using survival analysis, adjusting for sociodemographic variables. We tested effect modification by age, sex and socio-economic characteristics using interaction terms.

RESULTS

More physical activity facilities, cultural services and a greater level of greenness in the neighbourhood were associated with a lower risk of depression in our sample, even after adjusting for confounders. Material deprivation was associated with increased risk of depression, particularly in participants who were older or retired.

CONCLUSIONS

Characteristics of neighbourhoods were associated with the risk of depression in people with Type 2 diabetes and there were vulnerable subgroups within this association. Clinicians are encouraged to consider the neighbourhood environment of their patients when assessing the risk of depression. Future intervention research is need for health policy recommendations.

Total anomalous pulmonary venous connection. Long-term results following repair under 3 months of age

The surgical experience with total anomalous pulmonary venous connection (TAPVC) at the University of Louvain (Brussels) between the years 1975 and 1986 is reviewed. Nineteen patients aged two days to three months with TAPVC were studied. The types of TAPVC were supracardiac in 9 patients, cardiac in 4, infracardiac in 4 and mixed in 2. Profound hypothermia induced by surface cooling, limited cardiopulmonary by-pass and total circulatory arrest were used in all cases. The 4 early deaths concerned the first four neonates who were critically ill. All operative survivors are followed for a mean of 3.5 years (12 months to 8 years). There are two late deaths due to reoperation for pulmonary venous obstruction. All 13 survivors are well at last review. Eleven of them have been recatheterized 4 to 33 months after repair (19 months in average). The pulmonary artery and capillary pressures fell to a normal level after a few months. Ventricular function which was markedly depressed preoperatively, was evaluated by quantitative angiocardiography and echocardiography. It returned to normal late postoperatively. The hospital mortality for the repair of TAPVC in the neonates remains appreciable. Total correction at one operation is advisable. The incidence of postoperative pulmonary venous obstruction is of particular concern. The late postoperative functional and hemodynamic results are excellent. The repair of TAPVC can be considered curative.