The Association of Built Environment and Physical Activity in Older Adults: Using a Citywide Public Housing Scheme to Reduce Residential Self-Selection Bias

Abstract

Previous studies have documented numerous health benefits of conducting regular physical activity among older adults. The built environment is believed to be a key factor that can hinder or facilitate daily physical activity, such as walking and exercising. However, most empirical studies focusing on environment-physical activity associations exhibited residential self-selection bias with cross-sectional research design, engendering doubts about the impact of built environment on physical activity. To reduce this bias, we assessed physical activity behaviors of 720 Hong Kong older adults (≥65 years) residing in 24 public housing estates. The Hong Kong public housing scheme currently provides affordable rental flats for 2.1 million people or approximate 30% of total population. The applicants were allocated to one of 179 housing estates largely by family size and flat availability. Built environment characteristics were measured following the ‘5Ds’ principle: (street network) design, (land-use) diversity, density, distance to transit, and destination accessibility. Multilevel mixed models were used to explore the associations between the built environment and the different domains of physical activity (transportation walking, recreational walking, and recreational moderate-to-vigorous physical activity (MVPA) while controlling for potential estate-level socioeconomic and individual confounders. We found that transportation walking was positively associated with the number of bus stops and the presence of Mass Transit Railway (MTR) stations. Recreational MVPA was positively related to the number of recreational facilities. However, land-use mix was negatively related to transportation walking, recreational walking, and recreational MVPA. The findings of this study support a threshold effect in the environment-physical activity associations. Furthermore, large-scale public housing schemes involving random or semi-random residence assignment in many cities may provide opportunities to explore built environments and physical activity behavior, with the potential to overcome residential self-selection bias.

Built environment for physical activity—An urban barometer, surveillance, and monitoring

“…within 30 minutes travel, and design which promotes walkable, safe and attractive catchment areas are recommended . These should include well‐networked, comfortable, quality, safe, and adequate capacity public transport (a) facilities for active travel, wide pavements, with benches, water fountains safe and convenient crossings with limited car lanes (b) school play grounds and policies for playing (c) at worksite‐ user‐friendly stair cases, space and time for physical activity, walking paths (d) in developing countries‐ urgent attention to walkability from the public stations/bus stops, metro stops to their worksites or residences, safe useable subways (e) safe access to parks and public transport for women and children (f) wide active transport lanes, wide pavements, trees for shade and pedestrian dignity and prioritization, (g) universal designs across setting, and contextualized comfort (like tree shade to the elderly and differently abled) and (h) from a developed country perspective‐mixed land use and residential density . From a developing country perspective, there are other factors that need attention.…”

“…Besides, it would have a major role to prevent obesity, lower carbon emissions, and decelerate global warming. In the presence of existing reviews on physical activity and built environment, our review significantly adds to the science in three substantial and different ways. Firstly, it provides the developing country's perspective, which has been missing in all previous such work.…”

Health and the built environment in United States cities: measuring associations using Google Street View-derived indicators of the built environment

“…This analysis modeled the association between health outcomes and built environment indicators derived from Google Street View images for urban and suburban neighborhoods, given the composition of the 500 Cities Project data. Our use of GSV-derived indicators of built environment features contributes to a growing body of work that has focused on developing a wide variety of methods to measure these associations, particularly in urban areas [34][35][36][37][38]. These include GIS-measured street intersection density [34,36,38], residential density, land-use mix [38], and counts, population ratios, and densities of features of interest, including parks, intersections, subway stations, and green spaces [35,37].…”

Effects of Enriched Physical Activity Environments on Balance and Fall Prevention in Older Adults: A Scoping Review

“…The outcome measures that were reported in the selected studies included a combination of physical activity level (Colom et al, 2019;Forte et al, 2019;Gell, Rosenberg, Carlson, Kerr, & Belza, 2015;Giehl, Hallal, Corseuil, Schneider, & d'Orsi, 2016;Hanibuchi, Kawachi, Nakaya, Hirai, & Kondo, 2011;Huang, Kung, & Hu, 2018;Janssen et al, 2014;Kolbe-Alexander, Pacheco, Tomaz, Karpul, & Lambert, 2015;Li, Fisher, Brownson, & Bosworth, 2005; Y. Lu, Chen, Yang, & Gou, 2018;Mazzei, Gillan, & Cloutier, 2014;Nagel, Carlson, Bosworth, & Michael, 2008;Parra, Gomez, Fleischer, & Pinzon, 2010;Rosbergen, Grimley, Hayward, & Brauer, 2019;Rosbergen et al, 2017;Sato, Inoue, Du, & Funk, 2019;Timmermans et al, 2016;Winters et al, 2015), falling rates (Campbell et al, 2005;Cumming et al, 1999;Day et al, 2002;Lannin et al, 2007;Nikolaus & Bach, 2003;Pardessus et al, 2002;Stevens, Holman, Bennett, & De Klerk, 2001) Engel et al, 2016;Lannin et al, 2007;Lin, Wolf, Hwang, Gong, & Chen, 2007;Nicholson, McKean, & Burkett, 2014;Pighills, Torgerson, Sheldon, Drummond, & Bland, 2011;Rosbergen et al, 2017), ADL (Lannin et al, 2007;Law, Barnett, Yau, & Gray, 2013;Law, Fong, & Yau, 2018;Liu, Jones, Formyduval, & Clark, 2016;…”