Evidence linking physical activity to the built environment

1
Evidence linking physical activity to the built
environment
27th March, 2009 Health Challenge Wales,
Cardiff Sarah Rodgers, Ph.D.s.e.rodgers_at_swansea
.ac.uk
2
Outline

• Physical activity Active Living
• Walking
• Objective environment measurements
• Summary of evidence (World UK)
• Adding to the UK evidence base

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Built Environment

• Environment constructed by human activity
• Includes local land use patterns
• Distribution of buildings dwellings and
  destinations

Focus Sprawl The New Manifest
Destiny? Environews Focus A 620 VOLUME 112
NUMBER 11 August 2004 Environmental Health
Perspectives
4
National Statistics Office

• The 5 most popular sports, games or physical
  activities among adults (2002) were
• walking (46)
• swimming (35)
• keep fit/yoga including aerobics and dance
  exercise (22)
• cycling (19) and
• cue sports - billiards, snooker and pool (17)

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Active Living Research
Health experts are broadening the definition of
physical activity from leisure-time activity to
active living
a lifestyle or way of life that integrates
physical activity into daily routines with the
goal of accumulating at least 30 minutes of
activity each day.
Orleans C, Kraft M, Marx J, McGinnis J. Why are
some neighborhoods active and others not? Ann
Behav Med 200325779.
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Multidisciplinary effort

• Handy et al. 2002. How the Built Environment
  Affects Physical Activity Views from Urban
  Planning. Am J Prev Med v 23
• Collaborative research efforts that build on the
  research paradigms of the fields of both urban
  planning and public health are essential to make
  further progress in the effort to build healthier
  and more liveable communities

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Can the physical environment determine physical
activity levels?

• Self-selection
• active people choose to live in walkable
  environments.
• Environmental determinism
• walkable environments encourage individuals to be
  active.
• Ewing, R. 2005. Can the physical environment
  determine physical activity levels? Exercise and
  Sport Sciences Reviews 33 69-75.

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Built Environment and Walking

• Against walking
• Lots of traffic
• Steep gradient
• Circuitous route
• Nowhere to interesting to walk
• High crime area
• Large car parks

• For walking
• Intermittent traffic
• Not too steep
• Numerous interesting destinations within walking
  distance (e.g. 1 km)
• Grid streets for direct route
• Safe and pleasant walkways

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Geographic Information Systems and Walkability
Literature

• Several authors who have used GIS for
  walkability calculations
• Moudon and Lee
• Urban Design and Planning, Texas
• Larry Frank
• Planning and Transport, British Columbia
• Eva Leslie
• Health and Social Development, S. Australia
• Billie Giles-Corti
• Centre for the Built Environment and Health, W
  Australia

2.5 times more likely to walk in highly walkable
area
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Linking objectively measured physical activity
with objectively measured urban form Findings
from SMARTRAQ. Frank et al. 2005 Am J Prev Med 28
(2) Supp 2
GIS term for walking limit buffer
Walking limit
1-km
Walking limit
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Built Environment Correlates of Walking A Review

• Saelens and Handy, 2008. Medicine and Science in
  Sports and Exercise. DOI 10.1249/MSS.0b013e31817c
  67a4
• USA example Lee, Vernez Moudon, 2006
• Controlled for demographic and perceived
  environmental factors
• 243/943 objective environment variables were
  significant
• More walking within 1km limit related to
• Fewer grocery stores, fewer educational land uses
  
• More grocery restaurant retail combinations
  within 1km straight-line distance

(Destinations, Distance, Density, and Route)
The 3 Ds R Quantifying land use and urban
form correlates of walking. Transport Res Part D.
11204-215
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Environmental and psychosocial correlates of
physical activity in Portugeuse and Belgian adults

• De Bourheauduij et al. 2005. Public Health Nutr.
  V8 p886-95
• Walking and cycling for transport, related to
  increased land use mix
• Walking for leisure related to higher
  availability of pavement (Portuguese only) and
  higher land use mix (Belgian only)

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Exploring obesogenic urban form Theory, policy
and practice

• Townsend and Lake 2008. Health and Place, doi
  10.1016/j.healthplace.2008.12.002
• Newcastle, UK. Architecture and Medical Schools

• More Physical Activity when the Built Environment
  has
• Higher residential densities
• Good levels of connectivity
• More Physical Activity when the Local Residents
  have
• Perceptions of safety
• Aesthetically pleasing landscaping

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Refining the UK design

• Commission for Architecture and Built Environment
  (CABE)
• High density, poor quality, characterless, car
  dominated housing developments
• Design quality will have a larger impact than
  density in UK
• Inviting walkways and cycling provisions needed,
  along with amenity (green) space
• Boundary wall means adjacent destinations are
  inaccessible

CABE (2005) Housing Audit Assessing the Design
Quality of New Homes
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Pathways to obesity Identifying local,
modifiable determinants of physical activity and
diet

• Stafford, Cummins et al. 2007.
• Physical/urban design characteristics
• Density, leisure centre access
• Also social context on health
• Crime, policing, physical dereliction

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Environmental characteristics
Individual characteristics

Crime
-

Policing
Social disorder

-
-
Physical dereliction
High physical activity

Leisure centres
Obesity
-
-
-
Urban sprawl
Good diet

Mixed commercial /residential land use
Demographic Socioeconomic characteristics

Supermarkets
-
Fig 1. Theoretical Model linking social and
physical environmental characteristics to obesity
Fast-Food Outlets
Stafford, Cummins, et al. Social Science
Medicine 65 (2007) p1882-1897
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Environmental characteristics
Individual characteristics

Crime
-

Social disorder
Policing

-
-
High physical activity
Physical dereliction

Leisure centres
Obesity
-
-
-
Urban sprawl
Good diet

Mixed commercial /residential land use
Demographic Socioeconomic characteristics

Supermarkets
-
Fig 1. Theoretical Model linking social and
physical environmental characteristics to obesity
Fast-Food Outlets
Stafford, Cummins, et al. Social Science
Medicine 65 (2007) p1882-1897
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Does everyone use the environment in the same way?

• Burke et al. 2007. Association of the Built
  Environment with Physical Activity and Obesity in
  Older Persons, AJPH v97 p486-492
• Walking is related to neighbourhood
  characteristics (e.g. small cluster of retail,
  grocery restaurant within 1 km)
• but not clear if walking frequency is related to
  obesity prevalence (and improved health?)

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Improved Health and wellbeing?
RALFs
Built environment

• HIRUs Secure Anonymised Information Linkage
  (SAIL) Database HIRUs environment database
• Limitation no perceptions from individuals
• Advantage obesity related chronic disease
  prevalence for thousands of
  anonymous individuals

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Environmental metrics and links to health data
Margaret Williams age 61 8 Main St,
Swansea Chronic Heart Disease -- --
David Williams age 65 8 Main St,
Swansea Diabetes -- --
Identifiable
Social Database
Anonymous
Same environmental metric e.g. Dwelling
density, Land use mix, metres to bus stop or GP
surgery
Same RALF cohabiting
GP Database
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Caerau Physical RegenerationGathering Evidence
Locally

• Objective area where people will choose to
  liveto help reverse the effects of decline
• Qualitative evaluation of whole project ?
• Community Paths
• Feasibility 2007, Initial works 2008
• Quantitative evaluation of physical activity?

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Will the local youth walk and cycle more often,
and do more physical activity, once new paths are
available?
Busy road no space for cyclists, unpleasant to
walk
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Caerau Physical RegenerationGathering Evidence
Locally

• Measure activity for 32 study participants
  (11-17yrs)
• 2009 ?
• Compare to 2010

Uses acceleration Converts to Metabolic
Equivalents (METS)
Actigraph Measures activity
Global Positioning System Where are they active?
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Caerau Park Physical Activity Study Results Year
1
GPS measures every 10 seconds

• Merged GPS and Actigraph results

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Summary

• Objective built environmental measures have been
  associated with obesogenic environments in the UK
• More UK evidence needed
• Social context cannot be ignored
• Routinely collected environment and health data
  are sufficient to obtain interesting (
  influential?) results
• Planners need to be able to make necessary changes

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Acknowledgements Professor Ronan Lyons CHIRAL
team Caroline Brooks and Rohan Dsilva Friends of
Brynheulog, Caerau
THANK YOU
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