Neighbourhood walkability and physical activity: moderating role of a physical activity intervention in overweight and obese older adults with metabolic syndrome

Abstract

Background While urban built environments might promote active ageing, an infrequently studied question is how the neighbourhood walkability modulates physical activity changes during a physical activity intervention programme in older adults. We assessed the influence of objectively assessed neighbourhood walkability on the change in physical activity during the intervention programme used in the ongoing PREvención con DIeta MEDiterránea (PREDIMED)-Plus trial. Method The present study involved 228 PREDIMED-Plus senior participants aged between 55 and 75, recruited in Palma de Mallorca (Spain). Overweight/obese older adults with metabolic syndrome were randomised to an intensive weight-loss lifestyle intervention or a control group. A walkability index (residential density, land use mix, intersections density) was calculated using geographic information systems (1 km sausage-network buffer). Physical activity was assessed using accelerometer and a validated questionnaire, at baseline and two follow-up visits (6-months and 1-year later). Generalised additive mixed models were fitted to estimate the association between the neighbourhood walkability index and changes in physical activity during follow-up. Results Higher neighbourhood walkability (1 z-score increment) was associated with moderate-to-vigorous accelerometer assessed physical activity duration, (β = 3.44; 95% CI = 0.52; 6.36 min/day). When analyses were stratified by intervention arm, the association was only observed in the intervention group (β = 6.357; 95% CI = 2.07;10.64 min/day) (P for interaction = 0.055). Conclusions The results indicate that the walkability of the neighbourhood could support a physical activity intervention, helping to maintain or increase older adults’ physical activity.

The association between the built environment and intervention-facilitated physical activity: a narrative systematic review

“…Studies were published between 2009 and 2021 (Table 2). Most studies (n = 16) recruited samples from populations with a known health risk, including metabolic disorders (e.g., diabetes risk, metabolic syndrome) [32,35], coronary heart disease risk factors [42], overweight or obesity [36], history of cancer [40], high blood pressure [51], and sedentary behaviour or physical inactivity [34,43,44,46,48] or a combination of risk factors [33,37,39]. Six studies included samples from general (non-clinical) populations [38,41,45,47,49,50].…”

“…Several studies recruited participants from specific demographically-defined subpopulations such as African American, Hispanic or Latino [38,44], low socioeconomic position [34,47,48], and males [40] or females only [38,39,44]. The target age of participants varied with some studies sampling older adults only [33,37,41,47], and the remainder including samples representative of multiple age groups (e.g., young, middle-aged, and older adults). Three studies recruited some [32] or all [39,51] participants from rural areas while all other studies recruited participants from urban areas.…”

Exploring the Mediating Effect of Physical Activities on Built Environment and Obesity for Elderly People: Evidence From Shanghai, China

“…The environment appears to play a more important role in the decline in functioning associated with aging; however, older adults have been the least studied age group, with inconsistent results ( 38 , 39 ). Colom et al ( 16 ) and King et al ( 12 ) discovered that older adults who lived in more walkable neighborhoods had higher levels of physical activity and a lower BMI. However, Berke et al ( 40 ) discovered that low BMI levels were not found in higher walkability neighborhoods, particularly for men.…”

“…Some scholars recently advocated further research into the specific mechanisms of the linkage between the built environment and obesity ( 29 , 42 ), as the built environment may work to influence overweight through mediators such as different levels of physical activity, travel mode, sedentary behavior, and social capital ( 16 , 21 , 26 , 43 ). According to Poortinga ( 44 ), the majority of the mediations of PA on neighborhood environment and obesity are limited, implying that there are other unobserved mediating variables that negatively affect health outcomes in highly walkable neighborhoods.…”

“…The physical characteristics of the urban environment have ever since influenced how city residents live and work, as well as having a direct impact on their mobility and social interactions ( 14 , 15 ). For example, Colom et al ( 16 ) discovered that older adults who lived in more walkable neighborhoods had higher levels of physical activity and a lower BMI. Hirsch et al ( 17 ), on the other hand, conducted a longitudinal study and discovered that the relationship between BMI and neighborhood walkability is weak in older adults.…”