Comparisons Between Rail-Trail Users and Nonusers and Men and Women\u27s Patterns of Use in a Suburban Community

Background: Physical activity research on trails is limited. We compared rail-trail users and nonusers on demographics, physical activity, and barriers/concerns about trail use; and described use among men and women. Methods: Four hundred thirteen adults completed a physical activity survey during fall 1998. Chi-square statistics and t-tests were used to compare trail users to nonusers, and men and women on trail use. Results: More trail users (79%) performed recreational physical activity ≥ 3 d/wk, compared to nonusers (47%). Walking was the most common activity for trail users and nonusers. Both groups shared concerns about safe access to the trail and certain trail conditions. A higher percentage of female versus male users traveled to the trail by walking, walked on the trail, used the trail with a friend, and perceived that if the trail were not available their activity would decrease. Conclusions: Trail users perform more recreational physical activity than nonusers. Gender differences in trail use patterns should be considered in the design and promotion of trails

Perceived Built Environment and Physical Activity in U.S. Women by Sprawl and Region

Background A number of studies have demonstrated relationships between the perceived built environment and physical activity among adults. However, little is known about whether these associations differ by U.S. region and level of urban sprawl. Purpose To examine associations between the perceived built environment and physical activity in U.S. women by region and urban sprawl. Methods Nurses\u27 Health Study II participants (N=68,968) completed four perceived neighborhood environment survey items in 2005. Logistic regression was used to estimate associations with meeting physical activity recommendations, adjusting for demographic and weight-status variables, and stratifying by region and sprawl. Data analyses were completed in 2011. Results Perceived proximity to shops/stores was positively associated with physical activity across regions and levels of sprawl (ORs=1.21–1.46). Perceived access to recreation facilities was also a positive physical activity correlate in most region–sprawl strata, with strongest relationships found in the West (ORs=1.31–1.70). Perceived crime and presence of sidewalks did not show statistically significant associations with physical activity in most region–sprawl strata, although ORs for perceived crime showed a consistent pattern of negative associations (ORs=0.60–0.95). A higher number of positive environmental attributes was associated with a greater odds of meeting physical activity recommendations. Conclusions Findings indicate that perceived proximity to shops/stores and access to recreation facilities are important correlates of physical activity for women, irrespective of region or sprawl

Trails and Physical Activity: A Review

To provide a synthesis of research on trails and physical activity from the public health, leisure sciences, urban planning, and transportation literatures. Methods: A search of databases was conducted to identify studies published between 1980 and 2008. Results: 52 studies were identified. The majority were cross-sectional (92*%) and published after 1999 (11%). The evidence for the effects of trails on physical activity was mixed among 3 intervention and 5 correlational studies. Correlates of trail use were examined in 13 studies. Several demographic (eg, race, education, income) and environmental factors (eg, land-use mix and distance to trail) were related to trail use. Evidence from 31 descriptive studies identified several facilitators and barriers to trail use. Economic studies (n = 5) examining trails in terms of health or recreational outcomes found trails are cost-effective and produce significant economic benefits. Conclusion: There is a growing btidy of evidence demonstrating important factors that should be considered in promoting trail use, yet the evidence for positive effects of trails on physical activity is limited. Further research is needed to evaluate the effects of trails on physical activity. In addition, trail studies that include children and youth, older adults, and racial and ethnic minorities are a research priority

Reliability of a Brief Intercept Survey for Trail Use Behaviors

Purpose: This study assessed test-retest reliability of an interviewer-administered trail survey. Methods: An intercept survey was conducted with adults using 2 paved trails in Indiana and South Carolina (N = 295; mean age = 46.9 ± 18 y). The survey included items on frequency and duration of trail use for recreation and transportation, other patterns of trail use, and sociodemographic characteristics. Fiftyfive adults completed the survey twice (2–16 d apart; mean = 7.4 ± 2.6 d). Test-retest reliability was assessed with Spearman rank correlation coefficients, Kappa coefficients, and percent agreement. Results: Kappa coefficients and percent agreement for 9 categorical items ranged from 0.65 to 0.96 and from 64.0% to 98.2%, respectively. Among these items, the lowest Kappas were found for perceived safety (0.65) and reported duration of visits for recreational purposes (0.67). Spearman rank correlation coefficients for travel distance to and on the trail and frequency of trail use during the past 7 days and past 4 weeks ranged from 0.62 to 0.93. Conclusion: Though further assessments of this survey with different populations and types of trails may be warranted, its overall high reliability indicates it can be used by researchers and practitioners in its current form

Factorial validity of an abbreviated Neighborhood Environment Walkability Scale for seniors in the Nurses’ Health Study

Background: Using validated measures of individuals’ perceptions of their neighborhood built environment is important for accurately estimating effects on physical activity. However, no studies to date have examined the factorial validity of a measure of perceived neighborhood environment among older adults in the United States. The purpose of this measurement study was to test the factorial validity of a version of the Abbreviated Neighborhood Environment Walkability Scale (NEWS-A) modified for seniors in the Nurses’ Health Study (NHS). Findings: A random sample of 2,920 female nurses (mean age = 73 ± 7 years) in the NHS cohort from California, Massachusetts, and Pennsylvania completed a 36-item modified NEWS-A for seniors. Confirmatory factor analyses were conducted to test measurement models for both the modified NEWS-A for seniors and the original NEWS-A. Internal consistency within factors was examined using Cronbach’s alpha. The hypothesized 7-factor measurement model was a poor fit for the modified NEWS-A for seniors. Overall, the best-fitting measurement model was the original 6-factor solution to the NEWS-A. Factors were correlated and internally consistent. Conclusions: This study provided support for the construct validity of the original NEWS-A for assessing perceptions of neighborhood environments in older women in the United States

Using Mixed-Methods to Examine Factors that Influence Exercise Prescription from Healthcare Providers: A Community-Engaged Research Project

Background: The American College of Sports Medicine\u27s Exercise is Medicine initiative supports promotion of physical activity by health care providers (HCPs). Exercise is Medicine recommends HCPs utilize strategies such as exercise prescriptions to increase and promote regular exercise and referrals to community-based exercise facilities (ExRx+). Research is needed to identify factors that will increase African-American patients\u27 ExRx+ engagement since little is known about factors that serve as facilitators or barriers to adherence. Aims: Using a community-engaged participatory research approach, the aims are to: 1) examine individual, interpersonal and environmental factors associated with ExRx+ adherence and 2) explore barriers and facilitators related to the referral process that are associated with ExRx+ adherence. Setting: Healthworks Community Fitness, a non-profit women\u27s fitness facility located in Dorchester, MA. Healthworks is the only gym in the Boston metro area which allows patients to exchange ExRx+ for a 3-month gym membership. Methods: Based on a socio-ecological framework, the mixed-methods protocol includes qualitative and quantitative methods implemented sequentially in two phases to explore factors associated with ExRx+ adherence. Adherence will be operationally defined as: 1) activation: patient redeems the ExRx+ for membership and 2) utilization: attendance during the 3 month membership. Quantitative data will focus on the patient\u27s individual (i.e, body mass index, self-efficacy) interpersonal (i.e, social support), and environmental (i.e, walkability, transportation) levels. Qualitative data will involve one-on-one interviews with patients, HCPs and Healthworks staff exploring facilitators and barriers to ExRx+ adherence. Results will inform the development of a culturally tailored intervention to promote ExRx+ adherence

Accelerometer and GPS Data to Analyze Built Environments and Physical Activity

Purpose: Most built environment studies have quantified characteristics of the areas around participants' homes. However, the environmental exposures for physical activity (PA) are spatially dynamic rather than static. Thus, merged accelerometer and global positioning system (GPS) data were utilized to estimate associations between the built environment and PA among adults. Methods: Participants (N = 142) were recruited on trails in Massachusetts and wore an accelerometer and GPS unit for 1-4 days. Two binary outcomes were created: moderate-to-vigorous PA (MVPA vs. light PA-to-sedentary); and light-to-vigorous PA (LVPA vs. sedentary). Five built environment variables were created within 50-meter buffers around GPS points: population density, street density, land use mix (LUM), greenness, and walkability index. Generalized linear mixed models were fit to examine associations between environmental variables and both outcomes, adjusting for demographic covariates. Results: Overall, in the fully adjusted models, greenness was positively associated with MVPA and LVPA (odds ratios [ORs] = 1.15, 95% confidence interval [CI] = 1.03, 1.30 and 1.25, 95% CI = 1.12, 1.41, respectively). In contrast, street density and LUM were negatively associated with MVPA (ORs = 0.69, 95% CI = 0.67, 0.71 and 0.87, 95% CI = 0.78, 0.97, respectively) and LVPA (ORs = 0.79, 95% CI = 0.77, 0.81 and 0.81, 95% CI = 0.74, 0.90, respectively). Negative associations of population density and walkability with both outcomes reached statistical significance, yet the effect sizes were small. Conclusions: Concurrent monitoring of activity with accelerometers and GPS units allowed us to investigate relationships between objectively measured built environment around GPS points and minute-by-minute PA. Negative relationships between street density and LUM and PA contrast evidence from most built environment studies in adults. However, direct comparisons should be made with caution since most previous studies have focused on spatially fixed buffers around home locations, rather than the precise locations where PA occurs

Relationships Between the Built Environment and Walking and Weight Status Among Older Women in Three U.S. States

There are few studies of built environment associations with physical activity and weight status among older women in large geographic areas that use individual residential buffers to define environmental exposures. Among 23,434 women (70.0±6.9 years; range = 57-85) in 3 states, relationships between objective built environment variables and meeting physical activity recommendations via walking and weight status were examined. Differences in associations by population density and state were explored in stratified models. Population density (odds ratio (OR)=1.04 [1.02,1.07]), intersection density (ORs=1.18-1.28), and facility density (ORs=1.01-1.53) were positively associated with walking. Density of physical activity facilities was inversely associated with overweight/obesity (OR=0.69 [0.49, 0.96]). The strongest associations between facility density variables and both outcomes were found among women from higher population density areas. There was no clear pattern of differences in associations across states. Among older women, relationships between accessible facilities and walking may be most important in more densely populated settings

Psychosocial and Environmental Factors Associated with Dog

Dog walking is associated with higher levels of physical activity (PA). However, not all dog owners walk their dog(s) at a level sufficient for health benefits. Therefore, identifying correlates of dog walking may help to inform the design of more effective interventions to promote this specific form of PA. The purpose of this study was to examine psychosocial and environmental correlates of dog walking and relationships of dog walking with overall PA. In 2010, 391 dog owners (Mage= 43.6±12.3 years) completed a survey. Multiple logistic regression and structural equation modeling were used to examine psychosocial and environmental correlates of dog walking status, weekly minutes of dog walking and relationships of dog walking with overall PA. Self-efficacy for dog walking, dog-related outcome expectancies, family social support, dog social support, and neighborhood walking environment were associated with a 1.3 to 5.6 greater odds of being a dog walker. Self-efficacy mediated relationships between family support, dog support, and presence of a yard and dog walking. Neighborhood environment, including the presence of greenery and trails, was also positively associated with duration of dog walking (β=0.17;

Development and Psychometric Testing of the Dogs and WalkinG Survey (DAWGS)

Purpose: Dog owners represent 40% of the population, a promising audience to increase population levels of physical activity. The purpose of this study was to develop and test the psychometric properties of a new instrument to assess social cognitive theory (SCT) constructs related to dog walking. Methods: Dog owners (N=431) completed the Dogs and WalkinG Survey (DAWGS). Survey items assessed dog walking behaviors, and self-efficacy, social support, outcome expectations, and outcome expectancies for dog walking. Test-retest reliability was assessed among 252 (58%) survey respondents who completed the survey twice. Factorial validity and factorial invariance by age and walking level were tested using confirmatory factor analysis. Results: DAWGS items demonstrated moderate test-retest reliability (r=.39-.79; k=.41-.89). Acceptable model fit was found for all subscales. All subscales were invariant by age and walking level, except self-efficacy, which showed mixed evidence of invariance. Conclusions: The DAWGS is a psychometrically sound instrument for examining individual and interpersonal correlates of dog walking