Preserving older adults' routine outdoor activities in contrasting neighborhood environments through a physical activity intervention
Introduction
The aging-associated chronic diseases and functional decline that are linked with inactive lifestyles are major public health challenges both in the U.S. and globally (World Health Organization, 2013, Schoenborn and Adams, 2010). With the increased infirmities and reduced function that often accompany aging among inactive adults, mobility disability and accompanying loss of independence become major threats to a vital old age (King and Guralnik, 2010, Field and Jette, 2007). For instance, maintaining the ability to engage in routine activities around or near the home, such as walking for errands, housework, and yard work, is significantly linked with continued independent living—a highly valued state among many older adults (Fried et al., 2011). In addition to its important impacts on chronic disease prevention and control, regular physical activity remains among the most powerful methods for maintaining day-to-day physical function and mobility into older age (Hirvensalo et al., 2000, Pahor et al., 2014). Regular participation in light- to moderate-intensity routine activities may also produce metabolic and other health-related benefits that, at least for some groups of less active older adults, may be similar to those obtained with more strenuous activities (Loprinzi et al., 2015). There is growing evidence of the health-enhancing benefits of such “lifestyle” activities for adults aged 65 years and older, particularly when engaged in regularly (Loprinzi et al., 2015, Buman et al., 2010). As a result, there is increasing emphasis on including a lifestyle lighter-intensity recommendation in national physical activity guidelines for older adults (Loprinzi et al., 2015, Sparling et al., 2015).
Unfortunately, a significant proportion of older adults get insufficient levels of regular physical activity to optimally maintain levels of daily function. This is particularly true where local environments are less supportive of walking (Satariano, 1997, King et al., 2011, Shumway-Cook et al., 2002). Walking and other routine activities (e.g., housework) remain important for older adults irrespective of the types of neighborhood environments in which they live (i.e., more vs. less compact). Other types of routine activities, such as outdoor yard work and gardening, may be particularly relevant for those older adults living in what has typically been labeled as “less compact” environments with lower residential density and fewer destinations, but larger yards. While outdoor activities such as walking and yard work can provide enhancements in wellbeing and quality of life for young and old alike (Hartig et al., 2014), the potential benefits of such light to moderate outdoor activities may be particularly important for the health and functioning of older adults (Cunningham et al., 1993, Carman, 2006, Wang and MacMillan, 2013, Chen and Janke, 2012, Kerr et al., 2012).
The Lifestyle Interventions and Independence for Elders Pilot (LIFE-P) Study of 70–89 year old sedentary adults at risk for mobility disability evaluated the 12-month effects of a program of aerobic plus strengthening exercise versus a health education control on aspects of lower-extremity physical function of particular relevance for the prevention of mobility disability (Pahor et al., 2006). The original study found that over the course of one year, scores on the SPPB and the 400-meter walk test were significantly improved in the physical activity relative to health education arm (p values < 0.001) (Pahor et al., 2006). Volume of moderate-intensity physical activity/week (consisting primarily of walking) increased significantly in the physical activity compared to health education arm (Pahor et al., 2006).
The current investigation is based on additional funding obtained at the close of LIFE-P to investigate impacts of stable neighborhood design characteristics on participants' intervention success. We specifically explored whether the compactness of the neighborhood in which a participant lived moderated the effects of the physical activity program in relation to increases in walking as well as maintenance of moderate-intensity gardening and yard work activities—important routine activities that have been linked observationally to such neighborhood characteristics (Frank et al., 2003, Frank et al., 2010). Neighborhood compactness was ascertained objectively using a validated urban design “walkability” index (Frank et al., 2009). We postulated that the physical activity intervention would be sufficiently robust to increase 12-month exercise - or leisure-related walking levels irrespective of neighborhood compactness. In contrast, we believed that the effects of neighborhood compactness could be especially salient for maintaining or increasing more utilitarian outdoor activities such as walking for errands or accomplishing gardening and yard work, which contribute directly to independent living. With respect to walking for errands, we explored whether the physical activity intervention would be generally helpful in maintaining this type of utilitarian walking and whether level of neighborhood compactness would make a difference in this age group (King et al., 2011). With respect to gardening and yard work, we explored whether the physical activity intervention would be helpful in maintaining such outdoor activities, particularly in less dense neighborhoods that typically allow for or require greater amounts of gardening and yard work activities.
Section snippets
Participants and procedures
LIFE-P was a multi-site randomized controlled single-blind trial which tested a physical activity intervention compared with a “healthy aging” education intervention (hereafter referred to as the health education arm) in sedentary older adults at risk for major mobility disability. The physical activity intervention targeted aerobic activities, which consisted primarily of brisk walking, as well as lower-extremity muscle strengthening, flexibility, and balance exercises. The intervention
Participants
Objective GIS-derived environmental data were evaluated for the 400 participants (94% of sample) who completed the 12-month CHAMPS questionnaire (physical activity arm: n = 205, 96.2%; health education: n = 195, 92.4%). Mean age was 76.7 ± 4.2 years; 69.5% were women; and 26.2% represented racial/ethnic minorities. The two arms had similar baseline characteristics (p values ≥ 0.13), and about half (48.5%) of participants in each arm lived in more compact neighborhoods (see Table 1). Neighborhood
Discussion
This randomized controlled investigation explored the potential moderating effects of neighborhood compactness on the impacts of a physical activity intervention, designed specifically to increase discretionary-time (exercise and leisure-based) physical activity, on routine outdoor activities that are often important for older adults' independent living, in addition to contributing to health enhancement as people age (Loprinzi et al., 2015). Irrespective of neighborhood compactness, the
Conclusion
In summary, the results of this experimental investigation indicate that, among older adults attempting to increase their regular physical activity levels, those living in less compact neighborhoods may be at particular risk for compensatory reductions in certain routine activities such as active transport. In contrast, older adults from less compact neighborhoods may particularly benefit from such physical activity programs through maintaining their ability to engage in other routine
Competing interests
The authors declare that they have no conflicts of interest. All authors read and approved the final manuscript.
Authors' contributions
AK: Conceived of this paper's investigation and its study design, participated in selection of measurements, oversaw portions of data collection, contributed to analysis and interpretation of results, and took the lead in writing the manuscript.
DS: Contributed to the investigation design and methods, data analysis and interpretation of results, wrote portions of the manuscript, edited the manuscript, approved final version of manuscript.
JB: Contributed to the investigation design and methods,
Acknowledgments
This investigation was supported by Public Health Service Grant #5R01HL089694 from the National Heart, Lung, & Blood Institute awarded to Dr. King. It was also supported by the Lifestyle Interventions and Independence for Elders Pilot Study, funded by a National Institutes of Health (NIH)/National Institute on Aging Cooperative Agreement (U01 AG22376), and was sponsored in part by the Intramural Research Program, National Institute on Aging, NIH. Dr. Gill is the recipient of an Academic
References (48)
- et al.
Correlates of physical activity: why are some people physically active and others not?
Lancet
(2012) - et al.
Linking objectively measured physical activity with objectively measured urban form: findings from SMARTRAQ
Am. J. Prev. Med.
(2005) - et al.
Energy balance during an 8-wk energy-restricted diet with and without exercise in obese women
Am. J. Clin. Nutr.
(1995) - et al.
Do neighborhood environments moderate the effect of physical activity lifestyle interventions in adults?
Health Place
(2010) - et al.
Aging in neighborhoods differing in walkability and income: associations with physical activity and obesity in older adults
Soc. Sci. Med.
(2011) - et al.
Environmental measures of physical activity supports: perception versus reality
Am. J. Prev. Med.
(2003) - et al.
Neighborhood walkability, fear and risk fo falling and response to walking promotion: the easy steps to health 12-month randomized controlled trial
Prev. Med. Rep.
(2015) - et al.
Neighborhood built environment and income: examining multiple health outcomes
Soc. Sci. Med.
(2009) - et al.
Active for life: final results from the translation of two physical activity programs
Am. J. Prev. Med.
(2008) Comfortable and maximum walking speed of adults aged 20-79 years: reference values and determinants
Age Ageing
(1997)
Objective light-intensity physical activity associations with rated health in older adults
Am. J. Epidemiol.
Re-creating ‘the backyard’ in senior communities
J. Active Aging
Gardening as a potential activity to reduce falls in older adults
J. Aging Phys. Act.
The role of the built environment in the disablement process
Am. J. Public Health
Determinants of independence in the elderly
Can. J. Appl. Physiol.
The Future of Disability in America
The lifestyle interventions and independence for elders study: design and methods
J. Gerontol. A Biol. Sci. Med. Sci.
Health and Community Design: the Impact of the Built Environment on Physical Activity
The development of a walkability index: application to the neighborhood quality of life study
Br. J. Sports Med.
Healthy aging and where you live: community design relationships with physical activity and body weight in older Americans
J. Phys. Act. Health
Multiple pathways from land use to health: walkability associations with active transportation, body mass index, and air quality
J. Am. Plan. Assoc.
Health outcome prioritization as a tool for decision making among older persons with multiple chronic conditions
Arch. Intern. Med.
Understanding physical activity environmental correlates: increased specificity for ecological models
Exerc. Sport Sci. Rev.
Endurance training does not enhance total energy expenditure in healthy elderly persons
Am. J. Phys.
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Dr. Salvo is now at the University of Texas Health Science Center at Houston School of Public Health, Austin, TX.