Jelle Van Cauwenberg

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.

Relationship between the physical environment and different domains of physical activity in European adults: a systematic review

BackgroundIn the past decade, various reviews described the relationship between the physical environment and different physical activity (PA) domains. Yet, the majority of the current review evidence relies on North American/Australian studies, while only a small proportion of findings refer to European studies. Given some clear environmental differences across continents, this raises questions about the applicability of those results in European settings. This systematic review aimed at summarizing Europe-specific evidence on the relationship between the physical environment and different PA domains in adults.MethodsSeventy eligible papers were identified through systematic searches across six electronic databases. Included papers were observational studies assessing the relationship between several aspects of the physical environment and PA in European adults (18-65y). Summary scores were calculated to express the strength of the relationship between each environmental factor and different PA domains.ResultsConvincing evidence on positive relationships with several PA domains was found for following environmental factors: walkability, access to shops/services/work and the composite factor environmental quality. Convincing evidence considering urbanization degree showed contradictory results, dependent on the observed PA domain. Transportation PA was more frequently related to the physical environment than recreational PA. Possible evidence for a positive relationship with transportation PA emerged for walking/cycling facilities, while a negative relationship was found for hilliness. Some environmental factors, such as access to recreational facilities, aesthetics, traffic- and crime-related safety were unrelated to different PA domains in Europe.ConclusionsGenerally, findings from this review of European studies are in accordance with results from North American/Australian reviews and may contribute to a generalization of the relationship between the physical environment and PA. Nevertheless, the lack of associations found regarding access to recreational facilities, aesthetics and different forms of safety are likely to be Europe-specific findings and need to be considered when appropriate interventions are developed. More research assessing domain-specific relationships with several understudied environmental attributes (e.g., residential density) is needed.

Environmental factors influencing older adults’ walking for transportation: a study using walk-along interviews

BackgroundCurrent knowledge on the relationship between the physical environment and walking for transportation among older adults (≥ 65u2009years) is limited. Qualitative research can provide valuable information and inform further research. However, qualitative studies are scarce and fail to include neighborhood outings necessary to study participants’ experiences and perceptions while interacting with and interpreting the local social and physical environment. The current study sought to uncover the perceived environmental influences on Flemish older adults’ walking for transportation. To get detailed and context-sensitive environmental information, it used walk-along interviews.MethodsPurposeful convenience sampling was used to recruit 57 older adults residing in urban or semi-urban areas. Walk-along interviews to and from a destination (e.g. a shop) located within a 15 minutes’ walk from the participants’ home were conducted. Content analysis was performed using NVivo 9 software (QSR International). An inductive approach was used to derive categories and subcategories from the data.ResultsData were categorized in the following categories and subcategories: access to facilities (shops & services, public transit, connectivity), walking facilities (sidewalk quality, crossings, legibility, benches), traffic safety (busy traffic, behavior of other road users), familiarity, safety from crime (physical factors, other persons), social contacts, aesthetics (buildings, natural elements, noise & smell, openness, decay) and weather.ConclusionsThe findings indicate that to promote walking for transportation a neighborhood should provide good access to shops and services, well-maintained walking facilities, aesthetically appealing places, streets with little traffic and places for social interaction. In addition, the neighborhood environment should evoke feelings of familiarity and safety from crime. Future quantitative studies should investigate if (changes in) these environmental factors relate to (changes in) older adults’ walking for transportation.

Understanding the relationships between the physical environment and physical activity in older adults: A systematic review of qualitative studies

BackgroundWhile physical activity (PA) provides many physical, social, and mental health benefits for older adults, they are the least physically active age group. Ecological models highlight the importance of the physical environment in promoting PA. However, results of previous quantitative research revealed inconsistencies in environmental correlates of older adults’ PA that may be explained by methodological issues. Qualitative studies can inform and complement quantitative research on environment-PA relationships by providing insight into how and why the environment influences participants’ PA behaviors. The current study aimed to provide a systematic review of qualitative studies exploring the potential impact of the physical environment on older adults’ PA behaviors.MethodsA systematic search was conducted in databases of various disciplines, including: health, architecture and urban planning, transportation, and interdisciplinary databases. From 3,047 articles identified in the physical activity, initial search, 31 articles published from 1996 to 2012 met all inclusion criteria. An inductive content analysis was performed on the extracted findings to identify emerging environmental elements related to older adults’ PA. The identified environmental elements were then grouped by study methodologies [indoor interviews (individual or focus groups) vs spatial methods (photo-voice, observations, walk-along interviews)].ResultsThis review provides detailed information about environmental factors that potentially influence older adults’ PA behaviors. These factors were categorized into five themes: pedestrian infrastructure, safety, access to amenities, aesthetics, and environmental conditions. Environmental factors especially relevant to older adults (i.e., access to facilities, green open spaces and rest areas) tended to emerge more frequently in studies that combined interviews with spatial qualitative methods.ConclusionsFindings showed that qualitative research can provide in-depth information on environmental elements that influence older adults’ PA. Future qualitative studies on the physical environment and older adults’ PA would benefit from combining interviews with more spatially-oriented methods. Multidisciplinary mixed-methods studies are recommended to establish quantitative relationships complemented with in-depth qualitative information.

Physical environmental factors related to walking and cycling in older adults: the Belgian aging studies

BackgroundSocio-ecological models emphasize the relationship between the physical environment and physical activity (PA). However, knowledge about this relationship in older adults is limited. Therefore, the present study aims to investigate the relationship between area of residence (urban, semi-urban or rural) and older adults walking and cycling for transportation and recreation. Additionally, relationships between several physical environmental factors and walking and cycling and possible moderating effects of area of residence, age and gender were studied.MethodsData from 48,879 Flemish older adults collected in 2004-2010 through peer research were analyzed. Walking, cycling and environmental perceptions were assessed using self-administered questionnaires. The Study Service of the Flemish Government provided objective data on municipal characteristics. Multilevel logistic regression analyses were applied.ResultsUrban participants were more likely to walk daily for transportation compared to rural (OR = 1.43; 95% CI = 1.22, 1.67) and semi-urban participants (OR = 1.32; 95% CI = 1.13, 1.54). Urban participants were less likely to cycle daily for transportation compared to semi-urban participants (OR = 0.72; 95% CI = 0.56, 0.92). Area of residence was unrelated to weekly recreational walking/cycling. Perceived short distances to services (ORs ranging from 1.04 to 1.19) and satisfaction with public transport (ORs ranging from 1.07 to 1.13) were significantly positively related to all walking/cycling behaviors. Feelings of unsafety was negatively related to walking for transportation (OR = 0.93, 95% CI = 0.91, 0.95) and recreational walking/cycling (OR = 0.95, 95% CI = 0.92, 0.97). In females, it was also negatively related to cycling for transportation (OR = 0.94, 95% CI = 0.90, 0.98).ConclusionsUrban residents were more likely to walk for transportation daily compared to semi-urban and rural residents. Daily cycling for transportation was less prevalent among urban compared to semi-urban residents. Access to destinations appeared to be important for promoting both walking and cycling for transportation and recreation across all demographic subgroups. Additionaly, feelings of unsafety were associated with lower rates of walking for transportation and walking/cycling for recreation in all subgroups and cycling for transportation in females. No clear patterns emerged for other environmental factors.

Relationship between neighborhood walkability and older adults' physical activity: results from the Belgian Environmental Physical Activity Study in Seniors (BEPAS Seniors)

BackgroundAdequate knowledge on environmental correlates of physical activity (PA) in older adults is needed to develop effective health promotion initiatives. However, research in this age group is scarce and most existing studies were conducted in North America. The present study aimed to examine relationships between GIS-based neighborhood walkability and objective and self-reported PA in community-dwelling Belgian older adults. Furthermore, moderating effects of neighborhood income levels were investigated.MethodsThe Belgian Environmental Physical Activity Study (BEPAS) for Seniors is a cross-sectional study in older adults (≥65xa0yrs) and was conducted between October 2010 and September 2012. Data from 438 older adults living in 20 neighborhoods across Ghent (Belgium) were analyzed. Stratification of selected neighborhoods was based upon objective walkability and neighborhood income. Participants wore an accelerometer during seven consecutive days to obtain objective levels of moderate-to-vigorous physical activity (MVPA). Self-reported levels of transportation walking/cycling and recreational walking/cycling were assessed using the International Physical Activity Questionnaire (long, last 7xa0days version) adapted for the elderly. Multi-level regression analyses were conducted.ResultsFindings showed a positive relationship between neighborhood walkability and weekly minutes of older adults’ self-reported walking for transportation (B = 4.63 ± 1.05;p < 0.001) and a negative relationship between walkability and accelerometer-derived low-light PA (B = −1.38 ± 0.62;p = 0.025). Walkability was not related to any measure of recreational PA. A walkability x income interaction was found for accelerometer-derived MVPA (B = -1.826 ± 1.03;p = 0.075), showing only a positive association between walkability and MVPA in low-income neighborhood residents.ConclusionsThis was the first European study to examine walkability-PA relationships in older adults. These Belgian findings suggest that a high neighborhood walkability relates to higher levels of older adults’ transport-related walking. As transport-related walking is an accessible activity for older adults and easy to integrate in their daily routine, policy makers and health promoters are advised to provide sufficient destinations and pedestrian-friendly facilities in the close vicinity of older adults’ residences, so short trips can be made by foot. Neighborhood income moderated the relationship between walkability and objectively-measured MVPA. Increasing total MVPA levels in older adults should be a key topic in development of promotion initiatives and special attention should be paid to low-income neighborhood residents.

The neighbourhood physical environment and active travel in older adults: a systematic review and meta-analysis

BackgroundPerceived and objectively-assessed aspects of the neighbourhood physical environment have been postulated to be key contributors to regular engagement in active travel (AT) in older adults. We systematically reviewed the literature on neighbourhood physical environmental correlates of AT in older adults and applied a novel meta-analytic approach to statistically quantify the strength of evidence for environment-AT associations.MethodsForty two quantitative studies that estimated associations of aspects of the neighbourhood built environment with AT in older adults (agedu2009≥u200965xa0years) and met selection criteria were reviewed and meta-analysed. Findings were analysed according to five AT outcomes (total walking for transport, within-neighbourhood walking for transport, combined walking and cycling for transport, cycling for transport, and all AT outcomes combined) and seven categories of the neighbourhood physical environment (residential density/urbanisation, walkability, street connectivity, access to/availability of services/destinations, pedestrian and cycling infrastructure, aesthetics and cleanliness/order, and safety and traffic).ResultsMost studies examined correlates of total walking for transport. A sufficient amount of evidence of positive associations with total walking for transport was found for residential density/urbanisation, walkability, street connectivity, overall access to destinations/services, land use mix, pedestrian-friendly features and access to several types of destinations. Littering/vandalism/decay was negatively related to total walking for transport. Limited evidence was available on correlates of cycling and combined walking and cycling for transport, while sufficient evidence emerged for a positive association of within-neighbourhood walking with pedestrian-friendly features and availability of benches/sitting facilities. Correlates of all AT combined mirrored those of walking for transport. Positive associations were also observed with food outlets, business/institutional/industrial destinations, availability of street lights, easy access to building entrance and human and motorised traffic volume. Several but inconsistent individual- and environmental-level moderators of associations were identified.ConclusionsResults support strong links between the neighbourhood physical environment and older adults’ AT. Future research should focus on the identification of types and mixes of destinations that support AT in older adults and how these interact with individual characteristics and other environmental factors. Future research should also aim to clarify dose-response relationships through multi-country investigations and data-pooling from diverse geographical regions.

Assessment of physical activity in older Belgian adults: validity and reliability of an adapted interview version of the long International Physical Activity Questionnaire (IPAQ-L)

BackgroundAdequate monitoring of older adults’ physical activity (PA) is essential to develop effective health promotion programs. The present study examined criterion validity and test-retest reliability of the long International Physical Activity Questionnaire (IPAQ-L), adapted for Belgian, community-dwelling older adults (65y and older).MethodsParticipants (nu2009=u2009434) completed the last seven days version of IPAQ-L, modified for the Belgian population of community-dwelling older adults. This elderly-adapted version of IPAQ-L combined vigorous and moderate activities, and questions on gait speed and recreational cycling were added. Furthermore, participants wore an ActiGraph GT3X(+) accelerometer for at least five days. Criterion validity was determined by comparing self-reported weekly minutes of moderate-to-vigorous physical activity (MVPA) and weekly minutes of total PA with accelerometer data, defined by two different cut points (Freedson vs. Copeland). To examine test-retest reliability, a subsample of 29 participants completed IPAQ-L for a second time within a ten day interval.ResultsIPAQ-L showed moderate criterion validity for measuring weekly minutes of MVPA and total PA (Spearman’s ρ range 0.33–0.40). However, plots on agreement between self-reported and accelerometer PA showed a systematic over-reporting of IPAQ-L for MVPA. In contrast, plots indicated that IPAQ-L under-estimated levels of total PA, however, this under-estimation of total PA was substantially lower than the observed over-reporting of MVPA. Test-retest reliability was moderate-to-good for work-related PA, domestic PA, MVPA and total PA (ICC range 0.52–0.81), but poorer for transportation and recreational PA (ICC 0.44 and 0.43, respectively).ConclusionsCriterion validity results suggest that IPAQ-L is more valid to measure older adults’ weekly minutes of total PA than weekly MVPA minutes. Moreover, results might imply that content validity of IPAQ-L can be improved if specific light-intensity PA items are incorporated into IPAQ-L. Test-retest reliability of IPAQ-L was moderate to good, except for weekly minutes of transportation and recreational PA, probably due to week-to-week variability of these behaviors.

Older adults' reporting of specific sedentary behaviors: validity and reliability

BackgroundPrevious questionnaires targeting older adults’ sedentary time have underestimated total sedentary time, possibly by not including all relevant specific sedentary behaviors. The current study aimed to investigate the criterion validity and test-retest reliability of a new questionnaire assessing a comprehensive set of sedentary behaviors. Additionally, we examined whether the criterion validity of the questionnaire differed according to age, gender and educational level.MethodsA sample of home-dwelling Belgian older adults (>64xa0years, nu2009=u2009508) completed a newly-developed questionnaire assessing twelve specific sedentary behaviors and wore an accelerometer for seven consecutive days as criterion measure. A subsample (nu2009=u200928) completed the questionnaire a second time to examine test-retest reliability. Data collection occurred between September 2010 and October 2012.ResultsCorrelational analyses examining self-reported total sitting time and accelerometer-derived sedentary time yielded a Spearman’s ρ of 0.30. Using the Bland-Altman regression procedure, self-reported total sitting time underestimated accelerometer-derived sedentary time by -82xa0minutes/day for a participant with an average level of sedentary time (539xa0minutes/day). Corresponding 95% limits of agreement were wide (-364, 200xa0minutes/day). Better, but still not ideal, validity findings were observed in the younger, male and tertiary-educated subgroups. Acceptable test-retest reliability (ICCu2009>u20090.70) was found for total sitting time, TV viewing, computer use, and driving a car.ConclusionValidity for older adults’ self-reported total sitting time against accelerometer-derived sedentary time was not strong, but comparable to previous studies. However, underestimation of total sedentary time was lower compared to previous studies, possibly explained by the inclusion of additional specific sedentary behaviors. Further research is needed to develop self-report tools and objective criterion measures that accurately measure engagement in (specific) sedentary behavior(s) among different subgroups of the older population.

Built environmental correlates of older adults’ total physical activity and walking: a systematic review and meta-analysis

BackgroundIdentifying attributes of the built environment associated with health-enhancing levels of physical activity (PA) in older adults (≥65xa0years old) has the potential to inform interventions supporting healthy and active ageing. The aim of this study was to first systematically review and quantify findings on built environmental correlates of older adults’ PA, and second, investigate differences by type of PA and environmental attribute measurement.MethodsOne hundred articles from peer-reviewed and grey literature examining built environmental attributes related to total PA met inclusion criteria and relevant information was extracted. Findings were meta-analysed and weighted by article quality and sample size and then stratified by PA and environmental measurement method. Associations (pxa0<xa0.05) were found in relation to 26 individual built environmental attributes across six categories (walkability, residential density/urbanisation, street connectivity, access to/availability of destinations and services, infrastructure and streetscape, and safety) and total PA and walking specifically. Reported individual- and environmental-level moderators were also examined.ResultsPositive environmental correlates of PA, ranked by strength of evidence, were: walkability (pxa0<xa0.001), safety from crime (pxa0<xa0.001), overall access to destinations and services (pxa0<xa0.001), recreational facilities (pxa0<xa0.001), parks/public open space (pxa0=xa0.002) and shops/commercial destinations (pxa0=xa0.006), greenery and aesthetically pleasing scenery (pxa0=xa0.004), walk-friendly infrastructure (pxa0=xa0.009), and access to public transport (pxa0=xa0.016). There were 26 individual differences in the number of significant associations when the type of PA and environmental measurement method was considered. No consistent moderating effects on the association between built environmental attributes and PA were found.ConclusionsSafe, walkable, and aesthetically pleasing neighbourhoods, with access to overall and specific destinations and services positively influenced older adults’ PA participation. However, when considering the environmental attributes that were sufficiently studied (i.e., in ≥5 separate findings), the strength of evidence of associations of specific categories of environment attributes with PA differed across PA and environmental measurement types. Future research should be mindful of these differences in findings and identify the underlying mechanisms. Higher quality research is also needed.