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The World Health Organization recommends strategies to improve urban design, public transportation, and recreation facilities to facilitate physical activity for non-communicable disease prevention for an increasingly urbanized global population. Most evidence supporting environmental associations with physical activity comes from single countries or regions with limited variation in urban form. This paper documents variation in comparable built environment features across countries from diverse regions. The International Physical Activity and the Environment Network (IPEN) study of adults aimed to measure the full range of variation in the built environment using geographic information systems (GIS) across 12 countries on 5 continents. Investigators in Australia, Belgium, Brazil, Colombia, the Czech Republic, Denmark, China, Mexico, New Zealand, Spain, the United Kingdom, and the United States followed a common research protocol to develop internationally comparable measures. Using detailed instructions, GIS-based measures included features such as walkability (i.e., residential density, street connectivity, mix of land uses), and access to public transit, parks, and private recreation facilities around each participant's residential address using 1-km and 500-m street network buffers. Eleven of 12 countries and 15 cities had objective GIS data on built environment features. We observed a 38-fold difference in median residential densities, a 5-fold difference in median intersection densities and an 18-fold difference in median park densities. Hong Kong had the highest and North Shore, New Zealand had the lowest median walkability index values, representing a difference of 9 standard deviations in GIS-measured walkability. Results show that comparable measures can be created across a range of cultural settings revealing profound global differences in urban form relevant to physical activity. These measures allow cities to be ranked more precisely than previously possible. The highly variable measures of urban form will be used to explain individuals' physical activity, sedentary behaviors, body mass index, and other health outcomes on an international basis. Present measures provide the ability to estimate dose–response relationships from projected changes to the built environment that would otherwise be impossible.
The year 2000 health objectives developed by the Public Health Service (U. S. Department of Health and Human Services, 1991) recognize the importance of dietary and physical activity behaviors in the maintenance of good health in adolescents (see Table 10-1). In this chapter, dietary and physical activity behaviors are discussed together, a pairing supported by both physiological and behavioral reasons. Physiologically, diet and physical activity in large part determine energy balance in the body and thus influence growth and body composition. Diet and physical activity have been found to be empirically associated in several studies (Blair, Jacobs, & Powell, 1985) and share many behavioral characteristics: they vary widely from one person to the next, they change daily within each individual, they are influenced by multiple variables, they can be performed either alone or in a social milieu and in many different settings, and they are resistant to change.
Ecological models of physical activity emphasize the effects of environmental influences. "Microscale" streetscape features that may affect pedestrian experience have received less research attention than macroscale walkability (e.g., residential density). The Microscale Audit of Pedestrian Streetscapes (MAPS) measures street design, transit stops, sidewalk qualities, street crossing amenities, and features impacting aesthetics. The present study examined associations of microscale attributes with multiple physical activity (PA) measures across four age groups. Areas in the San Diego, Seattle, and the Baltimore metropolitan areas, USA, were selected that varied on macro-level walkability and neighborhood income. Participants (n = 3677) represented four age groups (children, adolescents, adults, older adults). MAPS audits were conducted along a 0.25 mile route along the street network from participant residences toward the nearest non-residential destination. MAPS data were collected in 2009-2010. Subscale and overall summary scores were created. Walking/biking for transportation and leisure/neighborhood PA were measured with age-appropriate surveys. Objective PA was measured with accelerometers. Mixed linear regression analyses were adjusted for macro-level walkability. Across all age groups 51.2%, 22.1%, and 15.7% of all MAPS scores were significantly associated with walking/biking for transport, leisure/neighborhood PA, and objectively-measured PA, respectively. Supporting the ecological model principle of behavioral specificity, destinations and land use, streetscape, street segment, and intersection variables were more related to transport walking/biking, while aesthetic variables were related to leisure/neighborhood PA. The overall score was related to objective PA in children and older adults. Present findings provide strong evidence that microscale environment attributes are related to PA across the lifespan. Improving microscale features may be a feasible approach to creating activity-friendly environments.
More effective ways to improve lifestyle behaviors need to be developed. Two hundred forty adult patients at a preventive cardiology clinic were randomly assigned to receive either one or five sessions of behavioral instruction to improve cardiovascular risk behaviors. Results for 102 patients from 6-month follow-up data revealed few significant differences between the two groups. However, in the two groups combined, there were significant reductions in total calories, percent of calories from total fat, percent of calories from saturated and monounsaturated fat, and dietary cholesterol. Reductions were also found in systolic blood pressure, triglycerides, body mass index, and weight. In multiple regression analyses, changes in physiologic variables were primarily associated with baseline and demographic characteristics. Changes in total calories, percent of calories from polyunsaturated fat, and walking were predicted by changes in social support or knowledge. Although most patients improved, the intensity of behavior change instruction was not related to the amount of change in cardiovascular risk factors. (c) 2001 by CHF, Inc.
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Prevalence estimates of meeting the guidelines for physical activity based on various self-report measures were compared, and the effects of various scoring protocols on the estimates were evaluated.A sample of 575 university students aged 24.5 +/- 1.9 yr (56% women, 54% Euro-American) completed the Seven-Day Physical Activity Recall interview (PAR), Youth Risk Behavior Survey (YRBS), and National Health Interview Survey 1991 (NHIS). To determine the prevalence of meeting the ACSM (1990) fitness and the CDC/ACSM (1995) health-related guidelines, various scoring protocols were employed that closely approximated the recommendations. Protocols varied by whether frequency and duration or duration only were considered. For the health-related guidelines, scoring protocols also varied depending on the intensity of activities considered.Depending on the scoring protocol and instrument used, the proportion meeting the fitness guidelines ranged from 32 to 59%. The NHIS, YRBS, and PAR resulted in significantly different proportions of those meeting the health-related guideline, ranging from 4 to 70%.The type of measure as well as the scoring protocol affected prevalence estimates of meeting the physical activity guidelines. This study indicates the difficulty of comparing prevalence rates across studies using different measures.
71 When multiple measures of physical activity (PA) are analyzed individually, the significance of treatment effects are often found to be inconsistent. A composite score composed of several measures should provide a more reliable indicator of physical activity than any single measure. This study demonstrates the use of principal components analysis (PCA) to derive conceptually meaningful composite scores of PA. PCA uses weighted linear combinations of all items to create orthogonal composites. The study sample consisted of 547 university seniors who completed 5 self-report measures of PA: 7-day recall, YRBS college survey, stages of change, and a list of 25 PAs from NHIS. From the measures, a total of 14 individual indices were derived. The sample was 56% female, 60% Caucasian, 18% Latino and 12% Asian/Pacific Islander with a mean age of 24 years. PCA resulted in 2 interpretable factors. Variables with the strongest weights on component 1 (Cl) included vigorous PA, stretching, strengthening, toning, flexibility, and exercise stages of change(eigenvalue = 3.96). Strongest weights on component 2 (C2) included moderate, walking, and housework PA items (eigenvalue = 1.80). Providing evidence of validity, significant correlations were observed for Cl with diastolic blood pressure (r=-0.24, p<0.001) and step test recovery heart rate (r=-0.382, p<0.001) and for C2 with systolic blood pressure (r=-0.16, p<0.001). The findings demonstrate the appropriateness and utility of PCA for integrating multiple measures of physical activity.
Background: Few studies have assessed built environment correlates of active commuting in low-and-middle-income countries, but the different context could yield distinct findings. This cross-sectional study investigated associations between home neighbourhood environment characteristics and active commuting in Chennai, India.&nbsp;Methods: Adults (N = 370, 47.2% female, mean age = 37.9 years) were recruited from 155 wards in the metropolitan area of Chennai in southern India between January and June 2015. Participants self-reported their usual mode of commute to work, with responses recoded into three categories: (1) multi-modal or active commuting (walking and bicycling); (2) public transit; and (3) private transport. Environmental attributes around participants&rsquo; homes were assessed using the Neighborhood Environment Walkability Scale-India (NEWS-India). Associations between environmental characteristics and likelihood of active commuting and public transit use were modelled using logistic regression with private transport (driving alone or carpool) as the reference category, adjusting for age, gender, and household car ownership.&nbsp;Results: Consistent with other international studies, participants living in neighbourhoods with a mix of land-uses and a transit stop within a 10-minute walk from home were more likely to use active commuting (both&nbsp;p &lt; 0.01). Land-use mix was significantly associated with the use of public transit compared to private transport (aOR = 5.2, p = 0.002). Contrary to findings in high-income countries, the odds of active commuting were reduced with improved safety from crime (aOR = 0.2, p = 0.003), aesthetics (aOR = 0.2, p = 0.05) and street connectivity (aOR = 0.2, p = 0.003).&nbsp;Conclusions: Different environmental attributes were associated with active commuting, suggesting that these relationships are complex and may distinctly differ from those in high-income countries. Unexpected inverse associations of perceived safety from crime and aesthetics with active commuting emphasize the need for high quality epidemiologic studies with greater context-specificity in the study of physical activity in LMICs. Findings have public health implications for India and suggest that caution should be taken when translating evidence across countries.
Context: Environmental, policy, and societal changes are important contributors to the rapid rise in obesity over the past few decades, and there has been substantial progress toward identifying environmental and policy factors related to eating and physical activity that can point toward solutions. This article is a status report on research on physical activity and food environments, and it suggests how these findings can be used to improve diet and physical activity and to control or reduce obesity. Methods: This article summarizes and synthesizes recent reviews and provides examples of representative studies. It also describes ongoing innovative interventions and policy change efforts that were identified through conference presentations, media coverage, and websites. Findings: Numerous cross‐sectional studies have consistently demonstrated that some attributes of built and food environments are associated with physical activity, healthful eating, and obesity. Residents of walkable neighborhoods who have good access to recreation facilities are more likely to be physically active and less likely to be overweight or obese. Residents of communities with ready access to healthy foods also tend to have more healthful diets. Disparities in environments and policies that disadvantage low‐income communities and racial minorities have been documented as well. Evidence from multilevel studies, prospective research, and quasi‐experimental evaluations of environmental changes are just beginning to emerge. Conclusions: Environment, policy, and multilevel strategies for improving diet, physical activity, and obesity control are recommended based on a rapidly growing body of research and the collective wisdom of leading expert organizations. A public health imperative to identify and implement solutions to the obesity epidemic warrants the use of the most promising strategies while continuing to build the evidence base.
