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Neighborhood-based physical and social environment as correlates of physical activity and sedentary time in community-dwelling older adults

(2016)
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Abstract
Worldwide, the proportion of older adults (65 years and older) will increase substantially during the forthcoming years. Because aging goes together with decreased mobility and declining health, a higher number of older adults is at risk of institutionalization, and this will inevitably result in a higher health care burden. Given that regular physical activity and the reduction of periods of prolonged sedentary time have proven to have beneficial results for a wide range of health outcomes, it is recommendable to develop public health interventions aimed at reaching sufficient levels of physical activity in older adults, and limiting their sitting time. However, before effective promotion programs can be developed, it is necessary to assess these health behaviors adequately, and to identify multidimensional factors that influence these behaviors. Socio-ecological models posit that health behaviors can be explained by analyzing the interaction of the individual and his or her environment. The research undertaken for this doctoral thesis had three aims: First, it investigated the measurement properties of physical activity and sedentary behavior questionnaires, adapted for assessment in older adults. A second aim was to obtain a better understanding of the neighborhood physical and social environment in relation to older adults’ physical activity and sedentary behavior. Thirdly, it investigated the possible interplay between the neighborhood environment and multidimensional socio-ecological factors (health-related, psychological and social factors) to explain physical activity and sedentary behavior in community-dwelling older adults. Regarding the first aim, study results suggested that physical activity and sedentary behavior of older adults should be assessed using ‘all-inclusive questionnaires’. Such questionnaires, querying a wide range of light-to-vigorous physical activities and sedentary behaviors relevant to older adults, might have the greatest potential to reduce reporting bias. Especially for physical activity assessment, questionnaires should include a higher number of items on light-intensity activities, accompanied by clear and unambiguous descriptions of such activities. With regard to the second and third research question, findings showed that older adults living in neighborhoods with high, objectively-measured, ‘walkability’ also walked more for transport than their counterparts living in low-walkable neighborhoods. Increasing the accessibility of existing relevant destinations, for instance through the provision of shortcut alleyways for vulnerable road users or public transport opportunities to reach destinations located further away from one’s residence, seems to have been key in increasing older adults’ transport walking. In addition, study findings demonstrated that if both walkability and diversity in the social composition of the neighborhood were high, older adults walked even more for transport. Furthermore, the combination of high walkability and higher levels of neighboring (talking to neighbors and social interactions) was related to less sitting time. These findings suggest that destinations relevant for older adults should also incorporate social interaction opportunities where older adults can get in contact with older adults, as well as with other population subgroups living in their neighborhood. Our study results identified two subgroups of older adults that warrant special attention in future research. In the first place, only in low-income neighborhoods was it the case that living in a highwalkable area was also related to higher levels of physical activity. This suggests that environmental interventions might be beneficial for low-income neighborhood residents, who are not always easy to reach through individual-oriented programs. Secondly, those older adults with better physical functioning levels could be targeted. Findings implied that both a good physical functioning level and high neighborhood walkability might be necessary to motivate older adults to engage in transport walking. Given that the relation between physical functioning and transport walking may be reciprocal, these results suggest that living in a high-walkable neighborhood might attenuate the aging-related decrease in mobility for those with better functioning levels. Therefore, it could be advised that for transport walking, increasing neighborhood walkability may be beneficial, but only in those older adults who still have adequate levels of physical functioning. It could, therefore, be recommendable to persuade older adults to move into high-walkable neighborhoods while they can still benefit from such a neighborhood, namely when they still have adequate functioning levels to engage in transport walking. In general, for all older adults, objective neighborhood walkability was less relevant to recreational walking levels. To increase this type of physical activity in older adults, as well as to reduce sitting time, interventions aiming at enhancing psychosocial factors - such as perceived benefits for physical activity and social support to reduce sitting - may be effective promotion strategies. Findings from this doctoral dissertation can inspire researchers, health promoters and policy makers to conduct more research on the importance of creating a physical and social environment that is conducive to higher physical activity, reduced sitting time, and hence, effective ‘aging in place’.

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Citation

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Chicago
Van Holle, Veerle. 2016. “Neighborhood-based Physical and Social Environment as Correlates of Physical Activity and Sedentary Time in Community-dwelling Older Adults”. Ghent, Belgium: Ghent University. Faculty of Medicine and Health Sciences.
APA
Van Holle, V. (2016). Neighborhood-based physical and social environment as correlates of physical activity and sedentary time in community-dwelling older adults. Ghent University. Faculty of Medicine and Health Sciences, Ghent, Belgium.
Vancouver
1.
Van Holle V. Neighborhood-based physical and social environment as correlates of physical activity and sedentary time in community-dwelling older adults. [Ghent, Belgium]: Ghent University. Faculty of Medicine and Health Sciences; 2016.
MLA
Van Holle, Veerle. “Neighborhood-based Physical and Social Environment as Correlates of Physical Activity and Sedentary Time in Community-dwelling Older Adults.” 2016 : n. pag. Print.
@phdthesis{7208493,
  abstract     = {Worldwide, the proportion of older adults (65 years and older) will increase substantially during the forthcoming years. Because aging goes together with decreased mobility and declining health, a higher number of older adults is at risk of institutionalization, and this will inevitably result in a higher health care burden. Given that regular physical activity and the reduction of periods of prolonged sedentary time have proven to have beneficial results for a wide range of health outcomes, it is recommendable to develop public health interventions aimed at reaching sufficient levels of physical activity in older adults, and limiting their sitting time. However, before effective promotion programs can be developed, it is necessary to assess these health behaviors adequately, and to identify multidimensional factors that influence these behaviors. Socio-ecological models posit that health behaviors can be explained by analyzing the interaction of the individual and his or her environment.
The research undertaken for this doctoral thesis had three aims: First, it investigated the measurement properties of physical activity and sedentary behavior questionnaires, adapted for assessment in older adults. A second aim was to obtain a better understanding of the neighborhood physical and social environment in relation to older adults{\textquoteright} physical activity and sedentary behavior. Thirdly, it investigated the possible interplay between the neighborhood environment and multidimensional socio-ecological factors (health-related, psychological and social factors) to explain physical activity and sedentary behavior in community-dwelling older adults.
Regarding the first aim, study results suggested that physical activity and sedentary behavior of older adults should be assessed using {\textquoteleft}all-inclusive questionnaires{\textquoteright}. Such questionnaires, querying a wide range of light-to-vigorous physical activities and sedentary behaviors relevant to older adults, might have the greatest potential to reduce reporting bias. Especially for physical activity assessment, questionnaires should include a higher number of items on light-intensity activities, accompanied by clear and unambiguous descriptions of such activities.
With regard to the second and third research question, findings showed that older adults living in neighborhoods with high, objectively-measured, {\textquoteleft}walkability{\textquoteright} also walked more for transport than their counterparts living in low-walkable neighborhoods. Increasing the accessibility of existing relevant destinations, for instance through the provision of shortcut alleyways for vulnerable road users or public transport opportunities to reach destinations located further away from one{\textquoteright}s residence, seems to have been key in increasing older adults{\textquoteright} transport walking. In addition, study findings demonstrated that if both walkability and diversity in the social composition of the neighborhood were high, older adults walked even more for transport. Furthermore, the combination of high walkability and higher levels of neighboring (talking to neighbors and social interactions) was related to less sitting time. These findings suggest that destinations relevant for older adults should also incorporate social interaction opportunities where older adults can get in contact with older adults, as well as with other population subgroups living in their neighborhood.
Our study results identified two subgroups of older adults that warrant special attention in future research. In the first place, only in low-income neighborhoods was it the case that living in a highwalkable area was also related to higher levels of physical activity. This suggests that environmental interventions might be beneficial for low-income neighborhood residents, who are not always easy to reach through individual-oriented programs. Secondly, those older adults with better physical functioning levels could be targeted. Findings implied that both a good physical functioning level and high neighborhood walkability might be necessary to motivate older adults to engage in transport walking.
Given that the relation between physical functioning and transport walking may be reciprocal, these results suggest that living in a high-walkable neighborhood might attenuate the aging-related decrease in mobility for those with better functioning levels. Therefore, it could be advised that for transport walking, increasing neighborhood walkability may be beneficial, but only in those older adults who still have adequate levels of physical functioning. It could, therefore, be recommendable to persuade older adults to move into high-walkable neighborhoods while they can still benefit from such a neighborhood, namely when they still have adequate functioning levels to engage in transport walking. In general, for all older adults, objective neighborhood walkability was less relevant to recreational walking levels. To increase this type of physical activity in older adults, as well as to reduce sitting time, interventions aiming at enhancing psychosocial factors - such as perceived benefits for physical activity and social support to reduce sitting - may be effective promotion strategies.
Findings from this doctoral dissertation can inspire researchers, health promoters and policy makers to conduct more research on the importance of creating a physical and social environment that is conducive to higher physical activity, reduced sitting time, and hence, effective {\textquoteleft}aging in place{\textquoteright}.},
  author       = {Van Holle, Veerle},
  language     = {eng},
  pages        = {VI, 226},
  publisher    = {Ghent University. Faculty of Medicine and Health Sciences},
  school       = {Ghent University},
  title        = {Neighborhood-based physical and social environment as correlates of physical activity and sedentary time in community-dwelling older adults},
  year         = {2016},
}