Delfien Van Dyck

Relationship between the physical environment and physical activity in older adults: A systematic review

Previous reviews on children, adolescents and adults have reported consistent relationships between several physical environmental characteristics and physical activity (PA). This systematic review aims to provide a comprehensive overview of the literature concerning the relationship between the physical environment and PA in older adults. A systematic literature search resulted in the inclusion of 31 articles. Results were inconsistent but most of the studied environmental characteristics were reported not to be related to PA. More studies in different contexts utilizing longitudinal designs, standardized, reliable and validated PA and environmental measurements and investigating possible moderating effects are definitely warranted.

Physical activity in relation to urban environments in 14 cities worldwide : a cross-sectional study

BACKGROUND Physical inactivity is a global pandemic responsible for over 5 million deaths annually through its effects on multiple non-communicable diseases. We aimed to document how objectively measured attributes of the urban environment are related to objectively measured physical activity, in an international sample of adults. METHODS We based our analyses on the International Physical activity and Environment Network (IPEN) adult study, which was a coordinated, international, cross-sectional study. Participants were sampled from neighbourhoods with varied levels of walkability and socioeconomic status. The present analyses of data from the IPEN adult study included 6822 adults aged 18-66 years from 14 cities in ten countries on five continents. Indicators of walkability, public transport access, and park access were assessed in 1·0 km and 0·5 km street network buffers around each participants residential address with geographic information systems. Mean daily minutes of moderate-to-vigorous-intensity physical activity were measured with 4-7 days of accelerometer monitoring. Associations between environmental attributes and physical activity were estimated using generalised additive mixed models with gamma variance and logarithmic link functions. RESULTS Four of six environmental attributes were significantly, positively, and linearly related to physical activity in the single variable models: net residential density (exp[b] 1·006 [95% CI 1·003-1·009]; p=0·001), intersection density (1·069 [1·011-1·130]; p=0·019), public transport density (1·037 [1·018-1·056]; p=0·0007), and number of parks (1·146 [1·033-1·272]; p=0·010). Mixed land use and distance to nearest public transport point were not related to physical activity. The difference in physical activity between participants living in the most and least activity-friendly neighbourhoods ranged from 68 min/week to 89 min/week, which represents 45-59% of the 150 min/week recommended by guidelines. INTERPRETATION Design of urban environments has the potential to contribute substantially to physical activity. Similarity of findings across cities suggests the promise of engaging urban planning, transportation, and parks sectors in efforts to reduce the health burden of the global physical inactivity pandemic. FUNDING Funding for coordination of the IPEN adult study, including the present analysis, was provided by the National Cancer Institute of National Institutes of Health (CA127296) with studies in each country funded by different sources.

Neighborhood SES and walkability are related to physical activity behavior in Belgian adults.

OBJECTIVE To investigate whether neighborhood walkability (higher residential density, land use mix, street connectivity) is positively associated with physical activity in Belgian adults and whether this association is moderated by neighborhood SES. METHODS The Belgian Environmental Physical Activity Study (BEPAS) was conducted in Ghent, Belgium. Data were collected between May 2007 and September 2008. Twenty-four neighborhoods were selected, stratified on GIS-based walkability and neighborhood SES. In total, 1200 adults (aged 20-65 years; 50 per neighborhood) completed the International Physical Activity Questionnaire and wore an accelerometer for seven days. After omitting participants with missing accelerometer data, the final sample consisted of 1166 adults. RESULTS Living in a high-walkable neighborhood was associated with more accelerometer-based minutes of moderate-to-vigorous physical activity (38.6 vs. 31.8 min/day, p<0.001), transportational walking and cycling, recreational walking, and less motorized transport (all p<0.05). Low neighborhood SES was related to more cycling for transport and less motorized transport (all p<0.05). No interactions between walkability and neighborhood SES were found. CONCLUSIONS The BEPAS results generally confirmed the findings from Australia and the US showing that, in Europe, walkability is also positively related to physical activity. As neighborhood SES was not a significant moderator, walkability appears beneficial for all economic strata.

Neighbourhood Walkability and its Particular Importance for Adults With a Preference for Passive Transport

In this study, differences in physical activity between adults living in high versus low walkable neighbourhoods were examined. In Sint-Niklaas, Belgium, neighbourhood walkability was defined by geographical map data and observations. One high walkable and one low walkable neighbourhood were selected. A sample of 120 adults between 20 and 65 years old, agreed to participate in the study and wore a pedometer for seven days. Self-reported physical activity and psychosocial data were collected. Results showed that residents of the high walkable neighbourhood took more steps/day and walked more for transport in their neighbourhood. Further analyses showed that living in a high walkable neighbourhood was associated with taking more steps, especially in adults with a preference for passive transport and/or a low intention to walk or cycle. In a health promotion context, these results are very promising.

Objectively measured walkability and active transport and weight-related outcomes in adults: a systematic review

ObjectivesThe aim of this study was to investigate which GIS-based measures of walkability (density, land-use mix, connectivity and walkability indexes) in urban and suburban neighbourhoods are used in research and which of them are consistently associated with walking and cycling for transport, overall active transportation and weight-related measures in adults.MethodsA systematic review of English publications using PubMed, Science Direct, Active Living Research Literature Database, the Transportation Research Information Service and reference lists was conducted. The search terms utilised were synonyms for GIS in combination with synonyms for the outcomes.ResultsThirty-four publications based on 19 different studies were eligible. Walkability measures such as gross population density, intersection density and walkability indexes most consistently correlated with measures of physical activity for transport. Results on weight-related measures were inconsistent.ConclusionsMore research is needed to determine whether walkability is an appropriate measure for predicting weight-related measures and overall active transportation. As most of the consistent correlates, gross population density, intersection density and the walkability indexes have the potential to be used in planning and monitoring.

Perceived Neighborhood Environmental Attributes Associated with Adults' Transport-related Walking and Cycling: Findings from the USA, Australia and Belgium

BackgroundActive transportation has the potential to contribute considerably to overall physical activity levels in adults and is likely to be influenced by neighborhood-related built environment characteristics. Previous studies that examined the associations between built environment attributes and active transportation, focused mainly on transport-related walking and were conducted within single countries, limiting environmental variability. We investigated the direction and shape of relationships of perceived neighborhood attributes with transport-related cycling and walking in three countries; and examined whether these associations differed by country and gender.MethodsData from the USA (Baltimore and Seattle), Australia (Adelaide) and Belgium (Ghent) were pooled. In total, 6,014 adults (20–65 years, 55.7% women) were recruited in high-/low-walkable and high-/low-income neighborhoods. All participants completed the Neighborhood Environmental Walkability Scale and the International Physical Activity Questionnaire. Generalized additive mixed models were used to estimate the strength and shape of the associations.ResultsProximity to destinations, good walking and cycling facilities, perceiving difficulties in parking near local shopping areas, and perceived aesthetics were included in a ‘cyclability’ index. This index was linearly positively related to transport-related cycling and no gender- or country-differences were observed. The ‘walkability’ index consisted of perceived residential density, land use mix access, proximity of destinations and aesthetics. A non-linear positive relationship with transport-related walking was found. This association was stronger in women than in men, and country-specific associations were identified: the strongest association was observed in Seattle, the weakest in Adelaide. In Ghent, the association weakened at higher levels of walkability.ConclusionsFor cycling, consistent correlates were found in the three countries, but associations were less straightforward for transport-related walking. Moreover, the identified neighborhood environmental correlates were different for walking compared to cycling. In order to further clarify the shape of these associations and reach more specific international guidelines for developing walkable and bikeable neighborhoods, future studies should include even more countries to maximize environmental variability.

Objectively measured sedentary time and physical activity time across the lifespan: a cross-sectional study in four age groups

BackgroundFrom a health perspective it is suggested to promote a positive balance between time spent in light intensity physical activity (LIPA) and sedentary behaviour (SB) (i.e. spending more time in LIPA than time spent in SB). However, no studies have reported prevalence rates of the LIPA-SB balance yet. The aim of this study was to objectively investigate the time spent in SB, in LIPA and moderate-to-vigorous intensity physical activity (MVPA) in four Belgian age groups and to explore which proportion of the population had a favorable balance between LIPA and SB and combined this with recommended amount of MVPA.MethodsAccelerometer data from 7 cross-sectional studies (N=2083) in four age groups (preschoolers, primary schoolchildren, secondary schoolchildren and adults) were aggregated. Differences in SB and PA between age groups and between men and women were determined by two-way MANCOVA. LIPA-SB balance was calculated and participants were categorized into one of four groups: (1) positive LIPA-SB balance (LIPA> SB) & sufficient MVPA (2) negative LIPA-SB balance & sufficient MVPA (3) positive LIPA-SB balance & insufficient MVPA (4) negative LIPA-SB balance & insufficient MVPA.ResultsFor the total sample, 55% of the waking time was spent in SB, 39% in LIPA and 6% in MVPA. Differences in SB between age groups was dependent from gender (p<0.001). Further, a positive LIPA-SB balance was assessed in 18% of the total sample and only 10% combined this positive balance with recommended amount of MVPA. Secondary schoolgirls were most at risk, with only 1% of the sample combining a positive LIPA-SB balance with sufficient MVPA. Another risk group was the large proportion (43%) of adult men who combined sufficient MVPA with a negative LIPA-SB balance.ConclusionA high proportion of the Belgian population is at risk if taking into account both SB and PA levels. Secondary schoolgirls have the unhealthiest SB and PA profile and are therefore an important target group for interventions both increasing MVPA and decreasing SB. In men more attention should be given in promoting a positive LIPA-SB balance independently from their compliance with the MVPA guidelines.

Associations between perceived neighborhood environmental attributes and adults’ sedentary behavior: Findings from the USA, Australia and Belgium

Sedentary behaviors are associated with multiple health problems, independently of physical activity. Neighborhood environment attributes might influence sedentary behaviors, but few studies have investigated these relationships. Moreover, all previous studies have been conducted within single countries, limiting environmental variability. We investigated the shape of associations between perceived neighborhood environment attributes and sedentary behavior in three countries; and whether these associations differed by country and gender. Data from U.S.A. (Seattle and Baltimore regions), Australia (Adelaide) and Belgium (Ghent) were pooled. Data collection took place between 2002 and 2008. In total, 6014 adults (20-65 years, 55.7% women) were recruited in high-/low-walkability and high-/low-income neighborhoods. All participants completed the International Physical Activity Questionnaire (domain-specific physical activity, transport-related sitting and overall time spent sitting) and the Neighborhood Environmental Walkability Scale (environmental perceptions). The number of destinations within a 20 min walk from home, perceiving few cul-de-sacs, good walking and cycling facilities, and traffic safety were included in an index of motorized transport correlates. This index was linearly negatively associated with motorized transport time, so the higher the scores on the index (more activity-friendliness), the lower the amount of motorized transport. No gender- or country-differences were identified. Perceived aesthetics and proximity of destinations were included in an index of overall sitting time correlates. A linear negative relationship with overall sitting time was found, but associations were stronger for men and not significant in Belgian adults. In conclusion, consistent and expected correlates were found for motorized transport in the three countries, but results were less clear for overall sitting time. Future studies should include even more countries to maximize environmental variability, but present findings suggest that neighborhoods may be designed to improve health through supporting more active and less sedentary transportation, which can be expected to have health benefits.

Criterion distances and correlates of active transportation to school in Belgian older adolescents

BackgroundSince physical activity levels in older adolescents have the potential to be increased by stimulating active transportation to school (ATS), the most important correlates of ATS should be determined before developing interventions, especially in those adolescents for whom the distance to school is feasible for active commuting. The main aims of this study were to determine criterion distances for ATS in Belgian older adolescents, to examine multidimensional correlates of ATS in adolescents living within a feasible distance from school and to investigate the associations of ATS with total physical activity and with other physical activities besides ATS.MethodsIn total, 1281 older adolescents (17-18 years) from 20 general secondary schools in East- and West-Flanders completed a questionnaire on physical activity behaviors, demographic factors and psychosocial and physical environmental correlates of physical activity. Distance to school was objectively measured using Routenet online route planner.ResultsIn total, 58.4% of the participants commuted actively to school. The criterion distance for ATS could be set at eight kilometers for cycling and two kilometers for walking. For those adolescents living within a feasible distance for ATS, gender, smoking status, walkability of the neighborhood and social modeling were associated with transportation mode choice. ATS was positively associated with total physical activity, but not significantly related to min/week of other physical activities.ConclusionsFor older adolescents living within eight kilometers of their school, interventions taking into account the correlates found to be related to ATS could possibly be effective to enhance ATS and to increase total physical activity levels. In the context of the overall physical activity decline in adolescence, also interventions targeting physical activity behaviors of adolescents living further away from school might be needed, but these interventions should probably emphasize alternative strategies.

Active living neighborhoods: is neighborhood walkability a key element for Belgian adolescents?

BackgroundIn adult research, neighborhood walkability has been acknowledged as an important construct among the built environmental correlates of physical activity. Research into this association has only recently been extended to adolescents and the current empirical evidence is not consistent. This study investigated whether neighborhood walkability and neighborhood socioeconomic status (SES) are associated with physical activity among Belgian adolescents and whether the association between neighborhood walkability and physical activity is moderated by neighborhood SES and gender.MethodsIn Ghent (Belgium), 32 neighborhoods were selected based on GIS-based walkability and SES derived from census data. In total, 637 adolescents (aged 13-15 year, 49.6% male) participated in the study. Physical activity was assessed using accelerometers and the Flemish Physical Activity Questionnaire. To analyze the associations between neighborhood walkability, neighborhood SES and individual physical activity, multivariate multi-level regression analyses were conducted.ResultsOnly in low-SES neighborhoods, neighborhood walkability was positively associated with accelerometer-based moderate to vigorous physical activity and the average activity level expressed in counts/minute. For active transport to and from school, cycling for transport during leisure time and sport during leisure time no association with neighborhood walkability nor, with neighborhood SES was found. For walking for transport during leisure time a negative association with neighborhood SES was found. Gender did not moderate the associations of neighborhood walkability and SES with adolescent physical activity.ConclusionsNeighborhood walkability was related to accelerometer-based physical activity only among adolescent boys and girls living in low-SES neighborhoods. The relation of built environment to adolescent physical activity may depend on the context.