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Exploring the cross-sectional association between outdoor recreational facilities and leisure-time physical activity : the role of usage and residential self-selection

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Abstract
Background: The availability of outdoor recreational facilities is associated with increased leisure-time physical activity (PA). We investigated how much of this association is attributable to selection effects, and explored whether usage of recreational facilities was an explanatory mechanism. Methods: We analysed data from 5199 participants in the SPOTLIGHT survey residing in five European urban regions. Adults completed a survey and a Google Street View-based virtual audit was conducted to objectively measure the availability of outdoor recreational facilities in the residential neighbourhood. We used negative binomial GEE models to examine the association between objective and subjective availability of outdoor recreational facilities and leisure-time PA, and explored whether this association was attenuated after adjustment for socioeconomic status and preference for neighbourhoods with recreational facilities (as indicators of self-selection). We examined whether reported use of recreational facilities was associated with leisure-time PA (as explanatory mechanism), and summarized the most important motivations for (not) using recreational facilities. Results: Subjective - but not objective - availability of outdoor recreational facilities was associated with higher levels of total leisure-time PA. After adjustment for self-selection (which attenuated the association by 25%), we found a 25% difference in weekly minutes of total leisure-time PA between individuals with and without self-reported availability of outdoor recreational facilities. For our study population, this translates to about 28 min per week Participants who reported outdoor recreational facilities to be present but indicated not to use them (RR = 1.19, 95% CI = 1.03;122), and those reporting outdoor recreational facilities to be present and to use them (RR = 1.33, 95% CI = 1.22, 1.45) had higher levels of total leisure-time PA than those who reported outdoor recreational facilities not to be present. Proximity to outdoor recreational facilities was the most important motivation for use. Conclusion: The modest attenuation in the association between availability of outdoor recreational facilities and self-reported leisure-time PA suggests that individuals' higher activity levels may be due more to the perceived availability of outdoor recreational facilities than to self-selection. The use of these facilities seemed to be an important underlying mechanism, and proximity was the main motivator for using recreational facilities.
Keywords
physical activity & health, Built environment, Motivations, Multilevel analysis, Perceptions, Selection effects, Usage, TRAVEL BEHAVIOR, BUILT ENVIRONMENT, NEIGHBORHOOD, ADULTS, DISPARITIES, FEATURES, IMPACTS, OBESITY, FOCUS

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Chicago
Mackenbach, Joreintje D, Maria G Matias de Pinho, Eline Faber, Nicole den Braver, Rosa de Groot, Helene Charreire, Jean-Michel Oppert, et al. 2018. “Exploring the Cross-sectional Association Between Outdoor Recreational Facilities and Leisure-time Physical Activity : the Role of Usage and Residential Self-selection.” International Journal of Behavioral Nutrition and Physical Activity 15.
APA
Mackenbach, J. D., Matias de Pinho, M. G., Faber, E., den Braver, N., de Groot, R., Charreire, H., Oppert, J.-M., et al. (2018). Exploring the cross-sectional association between outdoor recreational facilities and leisure-time physical activity : the role of usage and residential self-selection. INTERNATIONAL JOURNAL OF BEHAVIORAL NUTRITION AND PHYSICAL ACTIVITY, 15.
Vancouver
1.
Mackenbach JD, Matias de Pinho MG, Faber E, den Braver N, de Groot R, Charreire H, et al. Exploring the cross-sectional association between outdoor recreational facilities and leisure-time physical activity : the role of usage and residential self-selection. INTERNATIONAL JOURNAL OF BEHAVIORAL NUTRITION AND PHYSICAL ACTIVITY. 2018;15.
MLA
Mackenbach, Joreintje D, Maria G Matias de Pinho, Eline Faber, et al. “Exploring the Cross-sectional Association Between Outdoor Recreational Facilities and Leisure-time Physical Activity : the Role of Usage and Residential Self-selection.” INTERNATIONAL JOURNAL OF BEHAVIORAL NUTRITION AND PHYSICAL ACTIVITY 15 (2018): n. pag. Print.
@article{8565754,
  abstract     = {Background: The availability of outdoor recreational facilities is associated with increased leisure-time physical activity (PA). We investigated how much of this association is attributable to selection effects, and explored whether usage of recreational facilities was an explanatory mechanism. 
Methods: We analysed data from 5199 participants in the SPOTLIGHT survey residing in five European urban regions. Adults completed a survey and a Google Street View-based virtual audit was conducted to objectively measure the availability of outdoor recreational facilities in the residential neighbourhood. We used negative binomial GEE models to examine the association between objective and subjective availability of outdoor recreational facilities and leisure-time PA, and explored whether this association was attenuated after adjustment for socioeconomic status and preference for neighbourhoods with recreational facilities (as indicators of self-selection). We examined whether reported use of recreational facilities was associated with leisure-time PA (as explanatory mechanism), and summarized the most important motivations for (not) using recreational facilities. 
Results: Subjective - but not objective - availability of outdoor recreational facilities was associated with higher levels of total leisure-time PA. After adjustment for self-selection (which attenuated the association by 25\%), we found a 25\% difference in weekly minutes of total leisure-time PA between individuals with and without self-reported availability of outdoor recreational facilities. For our study population, this translates to about 28 min per week Participants who reported outdoor recreational facilities to be present but indicated not to use them (RR = 1.19, 95\% CI = 1.03;122), and those reporting outdoor recreational facilities to be present and to use them (RR = 1.33, 95\% CI = 1.22, 1.45) had higher levels of total leisure-time PA than those who reported outdoor recreational facilities not to be present. Proximity to outdoor recreational facilities was the most important motivation for use. 
Conclusion: The modest attenuation in the association between availability of outdoor recreational facilities and self-reported leisure-time PA suggests that individuals' higher activity levels may be due more to the perceived availability of outdoor recreational facilities than to self-selection. The use of these facilities seemed to be an important underlying mechanism, and proximity was the main motivator for using recreational facilities.},
  articleno    = {55},
  author       = {Mackenbach, Joreintje D and Matias de Pinho, Maria G and Faber, Eline and den Braver, Nicole and de Groot, Rosa and Charreire, Helene and Oppert, Jean-Michel and Bardos, Helga and Rutter, Harry and Compernolle, Sofie and De Bourdeaudhuij, Ilse and Lakerveld, Jeroen},
  issn         = {1479-5868},
  journal      = {INTERNATIONAL JOURNAL OF BEHAVIORAL NUTRITION AND PHYSICAL ACTIVITY},
  keyword      = {physical activity \& health,Built environment,Motivations,Multilevel analysis,Perceptions,Selection effects,Usage,TRAVEL BEHAVIOR,BUILT ENVIRONMENT,NEIGHBORHOOD,ADULTS,DISPARITIES,FEATURES,IMPACTS,OBESITY,FOCUS},
  language     = {eng},
  pages        = {11},
  title        = {Exploring the cross-sectional association between outdoor recreational facilities and leisure-time physical activity : the role of usage and residential self-selection},
  url          = {http://dx.doi.org/10.1186/s12966-018-0689-x},
  volume       = {15},
  year         = {2018},
}

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