Research articleObjective Measures of Neighborhood Environment and Physical Activity in Older Women
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
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2018, Health and PlaceCitation 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.
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.