Research article
Objective Measures of Neighborhood Environment and Physical Activity in Older Women

https://doi.org/10.1016/j.amepre.2005.02.001Get rights and content

Background

Regular physical activity is known to help prevent chronic disease and promote healthy aging. Yet, most older women are not regularly active. This study attempts to identify objectively measured attributes of the neighborhood environment that may be associated with physical activity levels in older women.

Methods

Sociodemographics and physical activity level, as measured by pedometer, were assessed in 158 overweight Caucasian and African-American postmenopausal women from southwestern Pennsylvania at the baseline evaluation of a randomized clinical trial in 2002–2003. Geographic information systems technology was used to obtain neighborhood-level data, including neighborhood socioeconomic status (SES) indicators, the median year that homes were built (as a proxy measure for urban form), and proximity to businesses and facilities. Multiple linear regression was used to test associations between individuals’ physical activity level and neighborhood characteristics.

Results

After controlling for individual age, race/ethnicity, education, smoking status, and body mass index, indicators of low neighborhood SES, living in a neighborhood with homes built between 1950 and 1969 (representing an urban form that is more pedestrian-friendly than after 1969), and living within walking distance (1500 m) of specific types of businesses and facilities were positively associated with individuals’ physical activity level measured by pedometer (p <0.05).

Conclusions

Results suggest that certain aspects of the neighborhood environment may have an important influence on the physical activity levels of postmenopausal women. Results warrant future research to clarify the role of these environmental attributes in other populations.

Introduction

Research has demonstrated that regular physical activity is beneficial in preventing or treating health conditions plaguing older women such as osteoporosis and related hip fractures,1, 2, 3, 4, 5 heart disease,6 arthritic pain,7, 8 depressive symptoms,9, 10, 11, 12, 13 and general physical limitations.13 Despite the proven benefits of regular physical activity, only 29% of women aged 45 to 6414 are meeting the Surgeon General’s recommendations of ≥30 minutes of moderate-intensity physical activity on most days of the week.15 It is important to examine the determinants of physical activity participation specific to older women so that age- and gender-appropriate interventions can be designed.

To date, research on the determinants of physical activity in older women has focused largely on examining individual demographics (e.g., age, race/ethnicity, socioeconomic status [SES])16, 17, 18, 19, 20, 21 and psychosocial factors (e.g., self-efficacy, intentions).16, 17, 18, 19, 20, 21 Recent research suggests that various aspects of the neighborhood environment, including functionality,22, 23, 24, 25, 26, 27, 28, 29 safety,25, 26, 28, 30, 31, 32, 33 aesthetics,27, 28, 31, 34, 35, 36 destinations,25, 27, 28, 29, 31, 33, 35, 37, 38, 39, 40 socioeconomic status,40, 41, 42, 43 and overall surroundings25, 37, 44, 45 may also influence physical activity behavior. However, few studies have explored these factors in older women.32, 34, 36, 37 None have used objective measures of the neighborhood environment.32, 34, 36, 37 Since two people living in the same environment may perceive their environment differently,46, 47 it can be difficult to translate research findings into environmental interventions. For example, a study found that self-report of the presence of unattended dogs was related to reporting any physical activity.34 However, activity level may influence perception of the environment,46, 47 that is, more active individuals may be more aware of unattended dogs than less active individuals. Therefore, this study examines objectively measured attributes of the neighborhood environment that are potential determinants of older women’s physical activity level: neighborhood SES, urban form, and proximity to businesses and facilities.

Neighborhoods have cultural or normative standards of behavior that are influenced by the SES of residents.48 In addition to one’s personal SES, the SES of a neighborhood may influence an individual’s choice to walk or participate in other forms of physical activity. A study in Perth, Australia found that residents living in low SES areas were less likely to do sufficient physical activity than residents in high SES areas, controlling for individual SES.40 Additionally, two U.S. studies41, 42 found that indicators of both low (percentage of residents living in poverty),41, 42 and high neighborhood SES (percentage of college educated42 and white residents41) were positively associated with residents’ walking activity, controlling for individual SES.

There is extensive evidence that urban form, which includes transportation systems, general patterns of land development, building design and orientation, and detailed aspects of the distribution of homes, workplaces, and other institutions,22, 31 has a direct impact on pedestrian travel.49 Traditionally, urban form has been difficult and expensive to measure because of its complex nature. However, home age, which is associated with density of interconnected networks of streets, presence of sidewalks, mix of business and residential uses, and building characteristics,22, 31 has recently been shown to be a viable proxy measure of urban form.23 A cross-sectional study found that living in homes built before 1973 was associated with walking a minimum of 1 mile at least 20 times a month compared to living in homes built after 1973.23

If residents live within walking distance of businesses or facilities they may make more utilitarian walking trips and/or participate in more physical activity at those locations, increasing their total physical activity level. One study found that an aggregate convenience score made up of self-report of having shops, a park/beach, and a cycle path within walking distance was related to walking for the purpose of exercise.35 Another study found that self-report of living within a 20-minute walk of two or more destinations was positively related to walking and total physical activity level.37 In addition, living within walking distance of particular facilities such as parks,27, 33, 37, 40 beaches,50 trails,27, 37 bikeways,33, 39 and recreation facilities,27, 33, 51, 52 was related to walking or physical activity behavior.

This study examines the relationships between physical activity levels of older women and neighborhood SES, urban form, and proximity to businesses and facilities, controlling for individual SES and health status indicators. These relationships are examined in a cohort of overweight and obese postmenopausal women (n =158) who are participants in a dietary and physical activity intervention trial. It is hypothesized that indicators of a high neighborhood SES (such as percentage of residents with a college degree), pedestrian-friendly urban form (determined with a proxy measure: median-year homes built pre-1950, most friendly, vs 1950–1969 vs post-1969, least friendly), and proximity to businesses and facilities are positively associated with individuals’ physical activity levels.

Total physical activity level, rather than neighborhood walking, is the outcome for several reasons. First, it can be measured objectively with a pedometer. In general, self-reports of walking and total physical activity are less accurate.37, 53 Additionally, neighborhood SES, urban form, and proximity to businesses and facilities may affect types of physical activity other than neighborhood walking. For instance, neighborhood SES may affect an individual’s decision to bike or use a gym, and proximity to some facilities, such as parks and golf courses, may be important because of activity performed at those facilities. Finally, increasing total physical activity level is a major public health goal.

Section snippets

Design

This cross-sectional study utilized data from the baseline evaluation of a randomized clinical trial of a lifestyle intervention in Pittsburgh PA. Neighborhood data were obtained from U.S. Census and geographic information systems (GIS) databases. This study was approved by the University of Pittsburgh Institutional Review Board. Informed consent was obtained from participants before their participation.

Subjects

Women on the Move through Activity and Nutrition Study (WOMAN) is a randomized clinical

Results

Individual characteristics of participants and their relationship with physical activity are shown in Table 1. Participants were primarily Caucasian (91%) with an average age of 57.3 years. By inclusion criteria, all were overweight (BMI ≥25) and almost half (49%) were obese (BMI ≥30). Their median physical activity level measured by pedometer equaled 6518 steps per day (25th percentile, 5018; and 75th percentile, 8927), which is within the normal range of physical activity for older adults.66,

Discussion

This study investigated associations between overweight postmenopausal women’s physical activity level and neighborhood SES, urban form, and proximity to businesses and facilities. Before results are discussed, study limitations are considered. This study examined a few objective measures of the neighborhood environment and did not include many environmental attributes that might also be related to physical activity level, such as neighborhood aesthetics and safety or more detailed aspects of

Conclusion

In this study, living within walking distance of a post office and golf course was positively associated with physical activity level, offering some support that proximity of businesses and facilities may increase physical activity levels of overweight postmenopausal women. Future work should examine a larger variety of businesses and facilities and attributes of businesses and facilities beyond proximity, such as quality, size, and cost, to determine the total contribution of businesses and

References (73)

  • K. Ball et al.

    Perceived environmental aesthetics and convenience and company are associated with walking for exercise among Australian adults

    Prev Med

    (2001)
  • P.J. Troped et al.

    Associations between self-reported and objective physical environmental factors and use of a community rail-trail

    Prev Med

    (2001)
  • B. Giles-Corti et al.

    Socioeconomic status differences in recreational physical activity levels and real and perceived access to a supportive physical environment

    Prev Med

    (2002)
  • C.E. Ross

    Walking, exercising, and smokingdoes neighborhood matter?

    Soc Sci Med

    (2000)
  • M.F. Hovell et al.

    Identifying correlates of walking for exercisean epidemiologic prerequisite for physical activity promotion

    Prev Med

    (1989)
  • B. Giles-Corti et al.

    The relative influence of individual, social and physical environment determinants of physical activity

    Soc Sci Med

    (2002)
  • A. Bauman et al.

    Geographical influences upon physical activity participationevidence of a “coastal effect”

    Aust N Z J Public Health

    (1999)
  • B.K. Sanderson et al.

    Personal, social, and physical environmental correlates of physical activity in rural African-American women in Alabama

    Am J Prev Med

    (2003)
  • C. Cooper et al.

    Physical activity, muscle strength, and calcium intake in fracture of the proximal femur in Britain

    BMJ

    (1988)
  • B.L. Drinkwater

    Exercise in the prevention of osteoporosis

    Osteoporos Int

    (1993)
  • G.P. Dalsky et al.

    Weight-bearing exercise training and lumbar bone mineral content in postmenopausal women

    Ann Intern Med

    (1988)
  • J.F. Aloia et al.

    Prevention of involutional bone loss by exercise

    Ann Intern Med

    (1978)
  • S.R. Cummings et al.

    Risk factors for hip fracture in white womenStudy of Osteoporotic Fractures Research Group

    N Engl J Med

    (1995)
  • W.H. Ettinger et al.

    A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritisThe Fitness Arthritis and Seniors Trial (FAST)

    JAMA

    (1997)
  • G.D. Batty

    Physical activity and coronary heart disease in older adultsa systematic review of epidemiological studies

    Eur J Public Health

    (2002)
  • T.C. Camacho et al.

    Physical activity and depressionevidence from the Alameda County Study

    Am J Epidemiol

    (1991)
  • M.J. Stones et al.

    Fitness and health evaluations by older exercisers

    Can J Public Health

    (1987)
  • J.S. Brach et al.

    Physical activity and functional status in community-dwelling older womena 14-year prospective study

    Arch Intern Med

    (2003)
  • C. Schoenborn et al.

    Leisure-time physical activity among adultsUnited States, 1997–98

    Safer Healthier People

    (2002)
  • U.S. Department of Health and Human Services. Physical activity and health: a report of the Surgeon General. Atlanta...
  • R. Shephard

    Determinants of Exercise in people aged 65 years and older

  • D.A. Lawlor et al.

    Is housework good for health? Levels of physical activity and factors associated with activity in elderly womenResults from the British Women’s Heart and Health Study

    J Epidemiol Community Health

    (2002)
  • J.M. Walsh et al.

    Predictors of physical activity in community-dwelling elderly white women

    J Gen Intern Med

    (2001)
  • A. McTiernan et al.

    Prevalence and correlates of recreational physical activity in women aged 50–64 years

    Menopause

    (1998)
  • A.C. King et al.

    Determinants of physical activity and interventions in adults

    Med Sci Sports Exerc

    (1992)
  • S. Handy

    Understanding the link between urban form and non-work travel behavior

    J Planning Educ Res

    (1996)
  • Cited by (173)

    • Association of change in the neighborhood obesogenic environment with colorectal cancer risk: The Multiethnic Cohort Study

      2020, SSM - Population Health
      Citation Excerpt :

      The impact of the neighborhood environment on cancer risk is an area of rapidly increasing interest in epidemiological research (Schule & Bolte, 2015). There is an established literature demonstrating the influence of neighborhoods on individual health behaviors, such as diet (An & Sturm, 2012; Caspi, Sorensen, Subramanian, & Kawachi, 2012; Mejia, Lightstone, Basurto-Davila, Morales, & Sturm, 2015; Reitzel et al., 2016) and physical activity (Keegan et al., 2012; King et al., 2005; Yang, Spears, Zhang, Lee, & Himler, 2012), and a growing body of evidence on its impact on health outcomes, including obesity (Barrientos-Gutierrez et al., 2017; Keegan et al., 2012; Lovasi, Hutson, Guerra, & Neckerman, 2009; Odoms-Young, Zenk, Karpyn, Ayala, & Gittelsohn, 2012; Shariff-Marco et al., 2017), cardiovascular disease (Dragano et al., 2009a, 2009b; Freedman, Grafova, & Rogowski, 2011) and cancer (Gomez et al., 2015), in particular colorectal cancer (CRC) (Doubeni et al., 2012; Kim, Masyn, Kawachi, Laden, & Colditz, 2010). Neighborhood social and built environment can affect the risk of colorectal cancer through a number of pathways (Gomez et al., 2015), one of which is through affecting health behaviors and psychological factors that promote obesity (Berrigan & Berger, 2019).

    • Why neighborhood park proximity is not associated with total physical activity

      2018, Health and Place
      Citation Excerpt :

      Even among our sample of urban adults with an average of 5 parks in their neighborhood, home neighborhood park PA accounted for only 3% of total PA. If parks in the home neighborhood contribute to total PA only through their use (i.e., home neighborhood park PA), then it is not surprising that many prior studies found no association between proximal parks and total PA (Carlson et al., 2012; Jilcott et al., 2007; King et al., 2005; Saelens et al., 2012; Strath et al., 2012). We tested the association between home neighborhoods parks and home neighborhood park PA, as well as non-home neighborhood park PA, other PA, and total PA.

    View all citing articles on Scopus

    Funding for this study was provided by the National Institutes of Health (grant 5 R01 HL066468-03) and the Robert Wood Johnson Foundation (grant 045466).

    No financial conflict of interest was reported by the authors of this paper.

    View full text