Review EssayRelationship between the physical environment and physical activity in older adults: A systematic review
Introduction
In the forthcoming decades the world population is predicted to face a large increase in proportion of older adults (≥65 years; Nelson et al., 2007, U.S. Census Bureau, 2010). Physical activity (PA) is an effective strategy to prevent an associated increase in chronic diseases and health care expenditures (Leung et al., 2008, Vogel et al., 2009). Since 60–70% of older adults do not meet the PA recommendations to obtain health benefits (Centers for Disease Control and Prevention, 2010, Eurobarometer 72.3, 2010), there is a strong need to promote PA in this population.
Promoting PA requires knowledge of correlates of PA (Baranowski et al., 1998). In the last decade most researchers adopted a social ecological model with growing attention to physical environmental correlates (Brownson et al., 2009, Brug et al., 2006, Trost et al., 2002). The physical environment is defined as the objective and perceived characteristics of the physical context in which people spend their time (e.g. home, neighborhood), including aspects of urban design (e.g. presence of sidewalks), traffic density and speed, distance to and design of venues for PA (e.g. parks), crime and safety (Davison and Lawson, 2006). Previous reviews on children, adolescents and adults have reported consistent relationships between physical environmental characteristics and PA (Bauman and Bull, 2007, Pont et al., 2009, Saelens and Handy, 2008, Wendel-Vos et al., 2007). Regardless of age, a meta-analysis by Duncan et al. (2005) revealed positive relationships of PA with the perceived presence of PA facilities, sidewalks, shops and services and perceiving traffic not to be a problem.
Different physical environmental characteristics are related to specific PA domains: transportation, recreation, household and occupation (Sallis et al., 2006). Aggregating different PA domains might obscure relationships. For example in adults, walkability, presence of street lights, enjoyable scenery and sidewalks and distance to a community rail-trail were positively related to transportation walking but not to total PA and other PA domains (Owen et al., 2007, Sallis et al., 2009b; Troped et al., 2003). PA in the household and occupation domains will not be discussed as these are less relevant regarding relationships with the physical environment.
The physical environment might be especially relevant for older adults as an increase in functional limitations and associated fear of moving outdoors might cause more difficulties in overcoming physical barriers towards PA (e.g. greater distances, slopes, obstacles) (Forsyth et al., 2009, Rantakokko et al., 2009, Rantakokko et al., 2010). However, only one review including six articles, previously studied the relationship between the physical environment and PA in older adults (Cunningham and Michael, 2004). Given the limited number of included articles, which all rely on self-reported PA and only one study that specifies a PA domain, no firm conclusion could be drawn.
With the increase in the number of studies examining associations between the physical environment and PA an updated review of the evidence would be timely. This review aims to provide a comprehensive overview of studies investigating the relationship between the physical environment and total PA and the following PA domains: recreational PA, total walking and cycling, recreational walking and transportation walking in older adults.
Section snippets
Methods
The literature search for this review started from a more extensive search concerning articles studying the relationship between the physical environment and PA in adolescents, adults and older adults.
Study characteristics
Study characteristics of the 31 articles are presented in Table 1. Only three studies investigated the relationship between the physical environment and PA prospectively. Twenty-one studies were conducted in North-America of which seven were in the city of Portland (Oregon). Sample sizes ranged from 72 to 18,370 participants and response rates from 10% to 88%. Five studies used the same sample or a subsample of the main sample recruited from 56 neighborhoods in Portland (Oregon) (Fisher et al.,
Discussion
Compared to reviews focusing on youth (Ferreira et al., 2006) and adults (Saelens and Handy, 2008), a limited number of studies focusing on older adults was retrieved. A promising finding is the increase in more recent articles published on this age group. However, there is still a lack of prospective studies which are necessary to infer causal relationships. The majority of studies were conducted in the US and caution should be paid when translating their findings to other countries. For
Acknowledgement
The first author was supported by a grant from the Research Council of the Vrije Universiteit Brussel.
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