Environments for active lifestyles: Sustainable environments may enhance human health

A growing number of studies focus on the role of environments in promoting active lifestyles.1 Being physically active in daily life, which is known to have significant health benefits,2 is easier to do in some environments than it is in others. Despite mounting evidence on the relationships between environmental characteristics, activity patterns, and health,3 most decisions on environmental planning and design appear to be made without considering their implications for residents’ activity and their health. In order to promote physically-active lifestyles through environmental design, it is desirable that environmental decision-making processes explicitly incorporate people’s activity patterns as a key criterion. However, those who are involved in environmental planning and design are not necessarily aware that their decisions could ultimately affect people’s health by influencing their behaviors. Although the importance of collaboration between planning, transportation and public health has been advocated for many years,1 there remains significant work to be done to realize such cooperation. This commentary discusses the possibility of making use of existing planning and design initiatives to promote active lifestyles. More specifically, I argue that environmental planning principles aiming for sustainability in urban or suburban areas, such as compact city and smart growth, could not only make environments conducive to physical activity, but also help reduce time in sedentary behavior— newly identified and significant health risk. Human health and environmental sustainability are both top-priority issues in today’s society. The planning and design of environments that can improve human and environmental health simultaneously are more likely to receive strong support from a wide range of stakeholders, thus have a better chance of being implemented

Content and construct validity of the Early Childhood Physical Environment Rating Scale (ECPERS)

The Early Childhood Physical Environment Rating Scale (ECPERS) has been designed to assess the quality of the physical environment of early childhood educational facilities. The purpose of the current research was to examine the content and construct validity of the scale. With regard to content validity, the vast majority of items (93%) in the scale were found to be important to very important by a diverse panel of 12 experts. Construct validity was measured as the degree of agreement between expert's global evaluation of a center and by using the 142-item ECPERS scale. The data from 13 experts assessing 13 different centers across Australia and New Zealand showed a very high correlation between expert's judgements and ECPERS score (r=0.85). The results indicate that ECPERS is a valid instrument for the measurement of the quality of the physical environment of early childhood centers relative to the potential for child development and learning

Perceived barriers to leisure-time physical activity in adults : an ecological perspective

Background: Perceived barriers are modifable correlates of participation in physical activity. Associations of specifc perceived barriers with participation in and level of walking for recreation, and other leisure-time physical activity (LTPA) were examined. Personal, social, and environmental factors associated with these perceived barriers were then examined. Methods: From 2003 to 2004, 2 surveys collected data on recreational walking and other LTPA, perceived barriers to participation, and personal, social, and environmental attributes, from 2194 Australian adults. Zero-infated negative binomial regression models examined associations of perceived barriers with walking and other LTPA. Generalized linear models identifed the correlates of these perceived barriers. Results: The perceived barriers of lack of motivation and time were associated with level of LTPA, while lack of motivation, poor health, and lack of facilities were associated with the odds of non participation in LTPA. Personal, social, and environmental factors independently contributed to variations in perceived barriers. Conclusions: Level and likelihood of participation in LTPA are associated with different perceived barriers. Perceived barriers are a function of both nonmodifable personal factors and potentially modifable personal, social, and environmental factors. These fndings suggest that the provision of relevant environmental opportunities and social support may effectively reduce perceived barriers to LTPA

Neighbourhood Environmental Attributes Associated with Walking in South Australian Adults: Differences between Urban and Rural Areas

Although the health benefits of walking are well established, participation is lower in rural areas compared to urban areas. Most studies on walkability and walking have been conducted in urban areas, thus little is known about the relevance of walkability to rural areas. A computer-assisted telephone survey of 2402 adults (aged ≥18 years) was conducted to determine walking behaviour and perceptions of neighbourhood walkability. Data were stratified by urban (n = 1738) and rural (n = 664). A greater proportion of respondents reported no walking in rural (25.8%) compared to urban areas (18.5%). Compared to urban areas, rural areas had lower walkability scores and urban residents reported higher frequency of walking. The association of perceived walkability with walking was significant only in urban areas. These results suggest that environmental factors associated with walking in urban areas may not be relevant in rural areas. Appropriate walkability measures specific to rural areas should be further researched

The impact of a new exercise facility on physical activity at the community level: A non-randomized panel study in Japan

Background Considering that building a sports facility is a major investment to promote population health, it is important to understand whether it is effective in increasing the level of physical activity (PA) in the community. This study examined the impact of building a new multipurpose exercise facility on community-level PA in Japan. Methods This non-randomised panel study compared two sites: an intervention site where a new exercise facility was built (opened after baseline data collection) and a control site where there was no such additional exercise facility. From each site, 3200 adult residents (aged 30–74 years) were randomly selected at baseline (2013) and at follow-up (2015). The number of participants retained for analysis was 845 at baseline and 924 at follow-up for the intervention site, and 821 at baseline and 1018 at follow-up for the control site. The outcomes were participants’ self-reported PA, perceived availability of PA facilities, awareness of others being active, and willingness to engage in PA. We examined the interaction terms between the sites and time of measurement in regression analyses to examine whether the magnitude of change from baseline to follow-up differed between the two sites. Results The changes in the proportion of participants meeting the PA guideline and those engaging in moderate-to-vigorous intensity PA were not significantly different between the intervention and control sites. The intervention site had a greater increase in the proportion of participants who were aware of PA facilities from baseline to follow-up than in the control site. The odds ratio for awareness of others being active approached significance, suggesting that there was a tendency at the intervention site towards a greater increase in the proportion of participants who noticed physically active people. Conclusions This study did not find community-level increases in PA after the construction of the exercise facility. However, a significant improvement in the awareness of PA facilities was observed in the intervention site. A sustained community-level effort to promote PA, possibly including social components, and a further tracking of residents’ PA are needed to take a full advantage of the new exercise facility and to assess its long-term impact. Trial registration UMIN-CTR UMIN000034116 (retrospectively registered: 13 September 2018)

Joint associations of multiple leisure-time sedentary behaviours and physical activity with obesity in Australian adults

BackgroundTelevision viewing and physical inactivity are independently associated with risk of obesity. However, how the combination of multiple leisure-time sedentary behaviours (LTSB) and physical activity (LTPA) may contribute to the risk of obesity is not well understood. We examined the joint associations of multiple sedentary behaviours and physical activity with the odds of being overweight or obese.MethodsA mail survey collected the following data from adults living in Adelaide, Australia (n = 2210): self-reported height, weight, six LTSB, LTPA and sociodemographic variables. Participants were categorised into four groups according to their level of LTSB (dichotomised into low and high levels around the median) and LTPA (sufficient: &ge; 2.5 hr/wk; insufficient: &lt; 2.5 hr/wk). Logistic regression analysis examined the odds of being overweight or obese (body mass index &ge; 25 kg/m2) by the combined categories.ResultsThe odds of being overweight or obese relative to the reference category (low sedentary behaviour time and sufficient physical activity) were: 1.54 (95% confidence interval [CI]: 1.20&ndash;1.98) for the combination of low sedentary behaviour time and insufficient physical activity; 1.55 (95% CI: 1.20&ndash;2.02) for the combination of high sedentary behaviour time and sufficient physical activity; and 2.26 (95% CI: 1.75&ndash;2.92) for the combination of high sedentary behaviour time and insufficient physical activity.ConclusionThose who spent more time in sedentary behaviours (but were sufficiently physically active) and those who were insufficiently active (but spent less time in sedentary behaviour) had a similar risk of being overweight or obese. Reducing leisure-time sedentary behaviours may be as important as increasing leisure-time physical activity as a strategy to fight against obesity in adults.<br /

Associations of neighborhood environmental attributes with adults' objectively-assessed sedentary time: IPEN adult multi-country study

Neighborhood environmental attributes have been found to be associated with residents' time spent walking and in physical activity, in studies from single countries and in multiple-country investigations. There are, however, mixed findings on such environmental relationships with sedentary (sitting) time, which primarily have used evidence derived from single-country investigations with self-reported behavioral outcome measures. We examined potential relationships of neighborhood environmental attributes with objectively-assessed sedentary time using data from 5712 adults recruited from higher and lower socio-economic status neighborhoods in 12 sites in 10 countries, between 2002 and 2011. Ten perceived neighborhood attributes, derived from an internationally-validated scale, were assessed by questionnaire. Sedentary time was derived from hip-worn accelerometer data. Associations of individual environmental attributes and a composite environmental index with sedentary time were estimated using generalized additive mixed models. In fully adjusted models, higher street connectivity was significantly related to lower sedentary time. Residential density, pedestrian infrastructure and safety, and lack of barriers to walking were related to higher sedentary time. Aesthetics and safety from crime were related to less sedentary time in women only. The predicted difference in sedentary time between those with the minimum versus maximum composite environmental index values was 71 min/day. Overall, certain built environment attributes, including street connectivity, land use mix and aesthetics were found to be related to sedentary behavior in both expected and unexpected directions. Further research using context-specific measures of sedentary time is required to improve understanding of the potential role of built environment characteristics as influences on adults' sedentary behavior.All authors declare financial support for the submitted work from the National Cancer Institute of the United States National Institutes of Health. Data collection in Hong Kong was supported by the HK Research Grants Council GRF grants (#HKU740907H and #747807H) and HKU URC Strategic Research Theme (Public Health). US data collection and Coordinating Center processing was supported by the NIH grants R01 HL67350 (NHLBI) and R01 CA127296 (NCI). The study conducted in Bogota was funded by Colciencias grant 519_2010, Fogarty International Center (NIH) and CeiBA. The contributions of Neville Owen were supported by NHMRC Program Grant #569940, NHMRC Senior Principal Research Fellowship #1003960, and by the Victorian Government's Operational Infrastructure Support Program. The Danish study was partly funded by the Municipality of Aarhus. Data collection in the Czech Republic was supported by the grant MEYS (# MSM 6198959221). Data collection in New Zealand was supported by the Health Research Council of New Zealand grant # 07/356. Data collection in Mexico was supported by the CDC Foundation which received an unrestricted grant from The Coca-Cola Company. The UK study was funded by the Medical Research Council under the National Preventive Research Initiative. Deborah Salvo was supported by a training grant from the CDC Foundation. James F Sallis received grants and personal fees from the Robert Wood Johnson Foundation outside of submitted work, grants and non-financial support from Nike, Inc. outside of submitted work, and is a consultant and receiver of royalties from SPARK Programs of School Specialty, Inc

Physical activity, television viewing time and 12 year changes in waist circumference

PURPOSE: Both moderate-to-vigorous physical activity (MVPA) and sedentary behavior can be associated with adult adiposity. Much of the relevant evidence is from cross-sectional studies or from prospective studies with relevant exposure measures at a single time point prior to weight gain or incident obesity. This study examined whether changes in MVPA and television (TV) viewing time are associated with subsequent changes in waist circumference, using data from three separate observation points in a large population-based prospective study of Australian adults. METHODS: Data were obtained from the Australian Diabetes, Obesity and Lifestyle study collected in 1999-2000 (baseline), 2004-05 (Wave 2), and 2011-12 (Wave 3). The study sample consisted of adults aged 25 to 74 years at baseline who also attended site measurement at three time points (n=3261). Multilevel linear regression analysis examined associations of initial five-year changes in MVPA and TV viewing time (from baseline to Wave 2) with 12-year change in waist circumference (from baseline to Wave 3), adjusting for well-known confounders. RESULTS: As categorical predictors, increases in MVPA significantly attenuated increases in waist circumference (p for trend&lt; 0.001). TV viewing time change was not significantly associated with changes in waist circumference (p for trend =0.06). Combined categories of MVPA and TV viewing time changes were predictive of waist circumference increases; compared to those who increased MVPA and reduced TV viewing time, those who reduced MVPA and increased TV viewing time had a 2cm greater increase in waist circumference (p=0.001). CONCLUSION: Decreasing MVPA emerged as a significant predictor of increases in waist circumference. Increasing TV viewing time was also influential, but its impact was much weaker than MVPA

Distinct associations of different sedentary behaviors with health-related attributes among older adults

Objective: Leisure-time sedentary behaviors (LTSBs) have been associated adversely with health outcomes. However, limited research has focused on different categories of LTSB. We aimed at identifying categories of LTSBs and examining their separate associations with indices of health among Japanese older adults. Methods: A postal survey collected data on self-reported health, psychological distress, body mass index, moderate-to-vigorous physical activity (MVPA), LTSBs (five behaviors) and socio-demographic characteristics from 1,580 Japanese older adults (67% response rate; 65-74 years) in 2010. Exploratory factor analysis was used to classify LTSBs. Odds ratios (ORs) were calculated for associations of LTSB categories with self-reported health, psychological distress, overweight, and lower MVPA. Data were analyzed in 2013. Results: Two categories of LTSB: passive sedentary time (consisting of TV time, listening or talking while sitting, and sitting around) and mentally-active sedentary time (consisting of computer-use and reading books or newspapers) were identified. Higher passive sedentary time was associated with a higher odds of being overweight (OR: 1.39, [95% CI: 1.08-1.80]), and lower MVPA (1.26, [1.02-1.54]). Higher mentally-active sedentary time was associated with lower odds of lower MVPA (0.70, [0.57-0.86]). Conclusions: Two types of sedentary time-passive and mentally-active-may play different roles in older adults' well-being

Residential proximity to urban centres, local-area walkability and change in waist circumference among Australian adults

Consistent associations have been observed between macro-level urban sprawl and overweight/obesity, but whether residential proximity to urban centres predicts adiposity change over time has not been established. Further, studies of local-area walkability and overweight/obesity have generated mixed results. This study examined 4-year change in adults’ waist circumference in relation to proximity to city centre, proximity to closest suburban centre, and local-area walkability. Data were from adult participants (n=2080) of a cohort study on chronic conditions and health risk factors in Adelaide, Australia. Baseline data were collected in 2000-03 with a follow-up in 2005-06. Multilevel regression models examined in 2015 the independent and joint associations of the three environmental measures with change in waist circumference, accounting for socio-demographic covariates. On average, waist circumference rose by 1.8 cm over approximately 4 years. Greater distance to city centre was associated with a greater increase in waist circumference. Participants living in distal areas (20 km or further from city centre) had a greater increase in waist circumference (mean increase: 2.4 cm) compared to those in proximal areas (9 km or less, mean increase: 1.2 cm). Counterintuitively, living in the vicinity of a suburban centre was associated with a greater increase in adiposity. Local-area walkability was not significantly associated with the outcome. Residential proximity to city centre appears to be protective against excessive increases in waist circumference. Controlled development and targeted interventions in the urban fringe may be needed to tackle obesity. Additional research needs to assess behaviours that mediate relationships between sprawl and obesity