[Show abstract][Hide abstract] ABSTRACT: Background
The World Health Organization recommends strategies to improve urban design, public transportation, and recreation facilities to facilitate physical activity for non-communicable disease prevention for an increasingly urbanized global population. Most evidence supporting environmental associations with physical activity comes from single countries or regions with limited variation in urban form. This paper documents variation in comparable built environment features across countries from diverse regions.
The International Physical Activity and the Environment Network (IPEN) study of adults aimed to measure the full range of variation in the built environment using geographic information systems (GIS) across 12 countries on 5 continents. Investigators in Australia, Belgium, Brazil, Colombia, the Czech Republic, Denmark, China, Mexico, New Zealand, Spain, the United Kingdom, and the United States followed a common research protocol to develop internationally comparable measures. Using detailed instructions, GIS-based measures included features such as walkability (i.e., residential density, street connectivity, mix of land uses), and access to public transit, parks, and private recreation facilities around each participant’s residential address using 1-km and 500-m street network buffers.
Eleven of 12 countries and 15 cities had objective GIS data on built environment features. We observed a 38-fold difference in median residential densities, a 5-fold difference in median intersection densities and an 18-fold difference in median park densities. Hong Kong had the highest and North Shore, New Zealand had the lowest median walkability index values, representing a difference of 9 standard deviations in GIS-measured walkability.
Results show that comparable measures can be created across a range of cultural settings revealing profound global differences in urban form relevant to physical activity. These measures allow cities to be ranked more precisely than previously possible. The highly variable measures of urban form will be used to explain individuals’ physical activity, sedentary behaviors, body mass index, and other health outcomes on an international basis. Present measures provide the ability to estimate dose–response relationships from projected changes to the built environment that would otherwise be impossible.
International Journal of Health Geographics 10/2014; 13:43. · 2.62 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Relationships between the neighborhood environment and children’s physical activity have been well documented in Western countries but are less investigated in ultra-dense Asian cities. The aim of this study was to identify the environmental facilitators and barriers of physical activity behaviors among Hong Kong Chinese children using nominal group technique. Methods: Five nominal groups were conducted among 34 children aged 10-11 years from four types of neighborhoods varying in socio-economic status and walkability in Hong Kong. Environmental factors were generated by children in response to the question “What neighborhood environments do you think would increase or decrease your willingness to do physical activity?” Factors were prioritized in order of their importance to children’s physical activity. Results: Sixteen unique environmental factors, which were perceived as the most important to children’s physical activity, were identified. Factors perceived as physical activity-facilitators included “Sufficient lighting”, “Bridge or tunnel”, “Few cars on roads”, “Convenient transportation”, “Subway station”, “Recreation grounds”, “Shopping malls with air conditioning”, “Fresh air”, “Interesting animals”, and “Perfume shop”. Factors perceived as physical activity-barriers included “People who make me feel unsafe”, “Crimes nearby”, “Afraid of being taken or hurt at night”, “Hard to find toilet in shopping mall”, “Too much noise”, and “Too many people in recreation grounds”. Conclusions: Specific physical activity-related environmental facilitators and barriers, which are unique in an ultra-dense city, were identified by Hong Kong children. These initial findings can inform future examinations of the physical activity-environment relationship among children in Hong Kong and similar Asian cities.
PLoS ONE 09/2014; 9(9):e106578. · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Parents¿ perceived informal social control, defined as the informal ways residents intervene to create a safe and orderly neighbourhood environment, may influence young children¿s physical activity (PA) in the neighbourhood. This study aimed to develop and test the reliability of a scale of PA-related informal social control relevant to Chinese parents/caregivers of pre-schoolers (children aged 3 to 5 years) living in Hong Kong.Methods
Nominal Group Technique (NGT), a structured, multi-step brainstorming technique, was conducted with two groups of caregivers (mainly parents; n¿=¿11) of Hong Kong pre-schoolers in June 2011. Items collected in the NGT sessions and those generated by a panel of experts were used to compile a list of items (n¿=¿22) for a preliminary version of a questionnaire of informal social control. The newly-developed scale was tested with 20 Chinese-speaking parents/caregivers using cognitive interviews (August 2011). The modified scale, including all 22 original items of which a few were slightly reworded, was subsequently administered on two occasions, a week apart, to 61 Chinese parents/caregivers of Hong Kong pre-schoolers in early 2012. The test-retest reliability and internal consistency of the items and scale were examined using intraclass correlation coefficients (ICC), paired t-tests, relative percentages of shifts in responses to items, and Cronbach¿s ¿ coefficient.ResultsThirteen items generated by parents/caregivers and nine items generated by the panel of experts (total 22 items) were included in a first working version of the scale and classified into three subscales: ¿Personal involvement and general informal supervision¿, ¿Civic engagement for the creation of a better neighbourhood environment¿ and ¿Educating and assisting neighbourhood children¿. Twenty out of 22 items showed moderate to excellent test-test reliability (ICC range: 0.40-0.81). All three subscales of informal social control showed acceptable levels of internal consistency (Cronbach ¿ >0.70).ConclusionsA reliable scale examining PA-related informal social control relevant to Chinese parents/caregivers of pre-schoolers living in Hong Kong was developed. Further studies should examine the factorial validity of the scale, its associations with Chinese children¿s PA and its appropriateness for other populations of parents of young children.
International Journal of Behavioral Nutrition and Physical Activity 07/2014; 11(1):87. · 3.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: While physical activity (PA) provides many physical, social, and mental health benefits for older adults, they are the least physically active age group. Ecological models highlight the importance of the physical environment in promoting PA. However, results of previous quantitative research revealed inconsistencies in environmental correlates of older adults' PA that may be explained by methodological issues. Qualitative studies can inform and complement quantitative research on environment-PA relationships by providing insight into how and why the environment influences participants' PA behaviors. The current study aimed to provide a systematic review of qualitative studies exploring the potential impact of the physical environment on older adults' PA behaviors.
International Journal of Behavioral Nutrition and Physical Activity 07/2014; 11(1):79. · 3.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Latino children are at high risk of becoming obese. Physical activity (PA) can help prevent obesity. Parents can influence children's PA through parenting practices. This study aimed to examine the independent contributions of (1) sociodemographic, (2) cultural, (3) parent perceived environmental, and (4) objectively measured environmental factors, to PA parenting practices.
BMC Public Health 07/2014; 14(1):707. · 2.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:Physical activity (PA) has been consistently implicated in the etiology of obesity, while recent evidence on the importance of sedentary time remains inconsistent. Understanding of dose-response associations of PA and sedentary time with overweight and obesity in adults can be improved with large-scale studies using objective measures of PA and sedentary time. The purpose of this study was to examine the strength, direction and shape of dose-response associations of accelerometer-based PA and sedentary time with BMI and weight status in 10 countries, and the moderating effects of study site and gender.Methods:Data from the International Physical activity and the Environment Network (IPEN) Adult study were used. IPEN Adult is an observational multi-country cross-sectional study, and 12 sites in 10 countries are included. Participants wore an accelerometer for seven consecutive days, completed a socio-demographic questionnaire and reported height and weight. In total, 5712 adults (18-65 years) were included in the analyses. Generalized additive mixed models, conducted in R, were used to estimate the strength and shape of the associations.Results:A curvilinear relationship of accelerometer-based moderate-to-vigorous PA and total counts/minute with BMI and the probability of being overweight/obese was identified. The associations were negative, but weakened at higher levels of moderate-to-vigorous PA (>50 min/day) and higher counts/minute. No associations between sedentary time and weight outcomes were found. Complex site- and gender-specific findings were revealed for BMI, but not for weight status.Conclusions:Based on these results, the current Institute of Medicine recommendation of 60 minutes/day of moderate-to-vigorous PA to prevent weight gain in normal-weight adults was supported. No relationship between sedentary time and the weight outcomes was present, calling for further examination. If moderator findings are confirmed, the relationship between PA and BMI may be country- and gender-dependent, which could have important implications for country-specific health guidelines.International Journal of Obesity accepted article preview online, 02 July 2014; doi:10.1038/ijo.2014.115.
International journal of obesity (2005) 07/2014; · 5.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Physical activity and sedentary behaviour are important contributors to adolescents' health. These behaviours may be affected by the school and neighbourhood built environments. However, current evidence on such effects is mainly limited to Western countries. The International Physical Activity and the Environment Network (IPEN) - Adolescent study aims to examine associations of the built environment with adolescent physical activity and sedentary behaviour across five continents.We report on the repeatability of measures of in-school and out-of school physical activity, plus measures of out-of-school sedentary and travel behaviours adopted by the IPEN - Adolescent study and adapted for Chinese-speaking Hong Kong adolescents participating in the international Healthy environments and active living in teenagers - (Hong Kong) [iHealt(H)] study, which is part of IPEN - Adolescent.
[Show abstract][Hide abstract] ABSTRACT: To compare the effect of 7 h of prolonged sitting on resting blood pressure with a similar duration of sitting combined with intermittent brief bouts of light-intensity or moderate-intensity physical activity.
[Show abstract][Hide abstract] ABSTRACT: Environmental changes are potentially effective population-level physical activity (PA) promotion strategies. However, robust multi-site evidence to guide international action for developing activity-supportive environments is lacking. We estimated pooled associations of perceived environmental attributes with objectively-measured PA outcomes; between-site differences in such associations; and, the extent to which perceived environmental attributes explain between-site differences in PA.
This was a cross-sectional study conducted in 16 cities located in Belgium, Brazil, Colombia, Czech Republic, Denmark, China, Mexico, New Zealand, Spain, United Kingdom, and USA. Participants were 6,968 adults residing in administrative units stratified by socio-economic status and transport-related walkability. Predictors were 10 perceived neighborhood environmental attributes. Outcome measures were accelerometry-assessed weekly minutes of moderate-to-vigorous PA (MVPA) and meeting the PA guidelines for cancer/weight gain prevention (420 min/week of MVPA).
Most perceived neighborhood attributes were positively associated with the PA outcomes in the pooled, site-adjusted, single-predictor models. Associations were generalizable across geographical locations. Aesthetics and land use mix - access were significant predictors of both PA outcomes in the fully-adjusted models. Environmental attributes accounted for within-site variability in MVPA corresponding to a 3 min/d or 21 min/week standard deviation. Large between-site differences in PA outcomes were observed: 15.9% to 16.8% of these differences were explained by perceived environmental attributes. All neighborhood attributes were associated with between-site differences in the total effects of the perceived environment on PA outcomes.
Residents' perceptions of neighborhood attributes that facilitate walking were positively associated with objectively-measured MVPA and meeting the guidelines for cancer/weight gain prevention at the within- and between-site levels. Associations were similar across study sites, lending support for international recommendations for designing PA-friendly built environments.
Medicine and science in sports and exercise 04/2014; · 4.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Regular participation in physical activity (PA) can help reduce the risk of overweight/obesity. Parental practices related to PA are modifiable determinants of preschoolers' PA that are still not well understood, especially in non-Western cultures. This qualitative explorative study aimed to identify parental practices encouraging or discouraging PA in Hong Kong preschoolers.
Nominal Group Technique (NGT) sessions (n=45; 6-9/group), complemented by a focus group (n=6) and individual interviews (n=12), were conducted with primary caregivers (mainly parents) of Hong Kong preschoolers to investigate what parents do to encourage (four groups) and discourage (two groups) PA in children. The groups were stratified by low and high neighborhood socio-economic status.
Participants generated 21 and 16 items describing practices encouraging and discouraging preschoolers' PA, respectively. Parental provision of instrumental, motivational, and conditional support were thought to encourage child's PA, while parental safety concerns, focus on academic achievement, lack of time and resources, and promotion of sedentary behaviors were thought to discourage child's PA.
Several parental practices that were deemed to encourage or discourage Hong Kong preschoolers' PA were identified. These can assist with development of a culturally-sensitive scale of PA parenting practices and inform future quantitative research.
Journal of Physical Activity and Health 04/2014; · 1.95 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study examined the strength and shape of associations between perceived environmental attributes and adults' recreational walking, using data collected from 13,745 adult participants in 12 countries. Perceived residential density, land use mix, street connectivity, aesthetics, safety from crime, and proximity to parks were linearly associated with recreational walking, while curvilinear associations were found for residential density, land use mix, and aesthetics. The observed associations were consistent across countries, except for aesthetics. Using data collected from environmentally diverse countries, this study confirmed findings from prior single-country studies. Present findings suggest that similar environmental attributes are associated with recreational walking internationally.
Health & Place 04/2014; 28C:22-30. · 2.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Walking is a suitable activity for older adults and has physical and mental health benefits. To devise interventions that impact on levels of walking it is necessary to first understand the purposes for which people walk and the destinations to which they walk. Using a 7-day diary and accelerometry, this study investigated destinations and purposes of walking in older adult residents of an ultra-dense Asian city. Participants reported an average of 17.1 walking trips per week and total weekly accelerometer/diary determined trip walking time averaged 735 minutes per week, much higher than reported for older adults in non-Asian settings. The most common destinations were within the neighborhood: parks and streets for recreation walking and shops and eating places for transport-related walking. Errands and eating were the most common purposes for transportation trips. The study results can help inform urban design to encourage walking.
[Show abstract][Hide abstract] ABSTRACT: There is considerable debate about the possibility of physical activity compensation. This study examined whether increased levels in physical activity and/or sedentary behaviour on one day were predictive of lower levels in these behaviours on the following day (compensatory mechanisms) among children.
Two hundred and forty-eight children (121 boys, 127 girls) aged 8-11 years from nine primary schools in Melbourne, Australia, wore a GT3X+ ActiGraph for seven consecutive days. Time spent in light (LPA) and moderate- to vigorous-intensity physical activity (MVPA) was derived using age-specific cut-points. Sedentary time was defined as 100 counts[BULLET OPERATOR]min. Meteorological data (temperature, precipitation, daylight hours) were obtained daily and matched to accelerometer wear days. Multilevel analyses (day, child, school) were conducted using generalized linear latent and mixed models.
On any given day, every additional 10 minutes spent in MVPA was associated with approximately 25 minutes less LPA and 5 minutes less MVPA the following day. Similarly, additional time spent in LPA on any given day was associated with less time in LPA and MVPA the next day. Time spent sedentary was associated with less sedentary time the following day. Adjusting for meteorological variables did not change observed compensation effects. No significant moderating effect of sex was observed.
The results are consistent with the compensation hypothesis, whereby children appear to compensate their physical activity or sedentary time between days. Additional adjustment for meteorological variables did not change the observed associations. Further research is needed to examine what factors may explain apparent compensatory changes in children's physical activity and sedentary time.
Medicine and science in sports and exercise 01/2014; · 4.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Latino preschoolers (3-5 year old children) have among the highest rates of obesity. Low levels of physical activity (PA) are a risk factor for obesity. Characterizing what Latino parents do to encourage or discourage their preschooler to be physically active can help inform interventions to increase their PA. The objective was therefore to develop and assess the psychometrics of a new instrument: the Preschooler Physical Activity Parenting Practices (PPAPP) among a Latino sample, to assess parenting practices used to encourage or discourage PA among preschool-aged children.
Cross-sectional study of 240 Latino parents who reported the frequency of using PA parenting practices. 95% of respondents were mothers; 42% had more than a high school education. Child mean age was 4.5 (+/-0.9) years (52% male). Test-retest reliability was assessed in 20%, 2 weeks later. We assessed the fit of a priori models using Confirmatory factor analyses (CFA). In a separate sub-sample (35%), preschool-aged children wore accelerometers to assess associations with their PA and PPAPP subscales.
The a-priori models showed poor fit to the data. A modified factor structure for encouraging PPAPP had one multiple-item scale: engagement (15 items), and two single-items (have outdoor toys; not enroll in sport-reverse coded). The final factor structure for discouraging PPAPP had 4 subscales: promote inactive transport (3 items), promote screen time (3 items), psychological control (4 items) and restricting for safety (4 items). Test-retest reliability (ICC) for the two scales ranged from 0.56-0.85. Cronbach's alphas ranged from 0.5-0.9. Several sub-factors correlated in the expected direction with children's objectively measured PA.
The final models for encouraging and discouraging PPAPP had moderate to good fit, with moderate to excellent test-retest reliabilities. The PPAPP should be further evaluated to better assess its associations with children's PA and offers a new tool for measuring PPAPP among Latino families with preschool-aged children.
International Journal of Behavioral Nutrition and Physical Activity 01/2014; 11(1):3. · 3.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Built-environment interventions have the potential to provide population-wide effects and the means for a sustained effect on behaviour change. Population-wide effects for adult physical activity have been shown with selected built environment attributes; however, the association between the built environment and adolescent health behaviours is less clear. This New Zealand study is part of an international project across 10 countries (International Physical Activity and the Environment Network-adolescents) that aims to characterise the links between built environment and adolescent health outcomes.
An observational, cross-sectional study of the associations between measures of the built environment with physical activity, sedentary behaviour, body size and social connectedness in 1600 New Zealand adolescents aged 12-18 years will be conducted in 2013-2014. Walkability and neighbourhood destination accessibility indices will be objectively measured using Geographic Information Systems (GIS). Physical activity and sedentary behaviours will be objectively measured using accelerometers over seven consecutive days. Body mass index will be calculated as weight divided by squared height. Demographics, socioeconomic status, active commuting behaviours and perceived neighbourhood walkability will be assessed using the Neighbourhood Environment Walkability Scale for Youth and psychosocial indicators. A web-based computer-assisted personal interview tool Visualisation and Evaluation of Route Itineraries, Travel Destinations, and Activity Spaces (VERITAS) and Global Positioning System (GPS) receivers will be used in a subsample of 300 participants. A qualitative research component will explore barriers and facilitators for physical activity in adolescents with respect to the built and social environment in a subsample of 80 participants.
The study received ethical approval from the Auckland University of Technology Ethics Committee (12/161). Data will be entered and stored into a secure (password protected) database. Only the named researchers will have access to the data. Data will be stored for 10 years and permanently destroyed thereafter. The results papers will be submitted for publication in peer-reviewed journals.
BMJ Open 01/2014; 4(4):e004475. · 1.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aim
To compare the effect of 7 hours of prolonged sitting on resting blood pressure with a similar duration of sitting combined with intermittent brief bouts of light-intensity or moderate-intensity physical activity.
Methods and Results
Overweight/obese adults (n = 19; aged 45-65 years) were recruited for a randomized three-treatment crossover trial with a one-week washout between treatments: 1) uninterrupted sitting; 2) sitting with 2 minute bouts of light-intensity walking at 3.2km/hr every 20 minutes; and, 3) sitting with 2 minute bouts of moderate-intensity walking at between 5.8-6.4km/hr every 20 minutes. After an initial 2 hour period seated, participants consumed a test meal (75g carbohydrate, 50g fat) and completed each condition over the next 5 hours. Resting blood pressure was assessed oscillometrically every hour as a single measurement, 5 minutes prior to each activity bout. GEE models were adjusted for sex, age, BMI, fasting blood pressure and treatment order.
After adjustment for potential confounding variables, breaking up prolonged sitting with light and moderate-intensity activity breaks was associated with lower systolic blood pressure [light:120 ± 1mmHg (estimated marginal mean ± SEM), P=0.002; moderate: 121 ± 1mmHg, P=0.02], compared to uninterrupted sitting (123 ± 1mmHg). Diastolic blood pressure was also significantly lower during both of the activity conditions (light: 76 ± 1mmHg, P=0.006; moderate: 77 ± 1mmHg, P=0.03) compared to uninterrupted sitting (79 ± 1mmHg). No significant between-condition differences were observed in mean arterial pressure or heart rate.
Regularly breaking up prolonged sitting may reduce systolic and diastolic blood pressure.
Trial Registration Number
Trial Registration Date
August 4th 2009
Nutrition, Metabolism and Cardiovascular Diseases. 01/2014;
[Show abstract][Hide abstract] ABSTRACT: This study examined the strength and shape of associations between perceived environmental attributes and adults’ recreational walking, using data collected from 13,745 adult participants in 12 countries. Perceived residential density, land use mix, street connectivity, aesthetics, safety from crime, and proximity to parks were linearly associated with recreational walking, while curvilinear associations were found for residential density, land use mix, and aesthetics. The observed associations were consistent across countries, except for aesthetics. Using data collected from environmentally diverse countries, this study confirmed findings from prior single-country studies. Present findings suggest that similar environmental attributes are associated with recreational walking internationally.
Health & Place 01/2014; 28:22–30. · 2.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: The main study objective was to examine the moderating effects of perceived enjoyment, barriers/benefits, perceived social support and self-efficacy, on the associations of perceived environmental attributes with walking for recreation and leisure-time moderate-to-vigorous physical activity, and whether these potential moderating effects differed by gender and study site. Methods: Data from three observational studies in the United States (Seattle and Baltimore), Australia (Adelaide), and Belgium (Ghent) were pooled. In total, 6014 adults (20-65 years, 55.7% women) were recruited in high-/low-walkable and high-/low-income neighborhoods. All participants completed the Neighborhood Environment Walkability Scale, a validated questionnaire on psychosocial attributes, and the International Physical Activity Questionnaire. General additive mixed models were conducted in R. Results: Enjoyment of physical activity, perceived barriers to physical activity, perceived benefits of physical activity, social support from family and friends, and self-efficacy for physical activity moderated the relationships of specific perceived environmental characteristics with walking for recreation and/or leisure-time moderate-to-vigorous physical activity. Overall, moderating effects were in the same direction: environmental perceptions were positively associated with leisure-time activity, but associations were strongest in adults with less positive scores on psychosocial attributes. The findings were fairly consistent across gender and study sites. Conclusions: The present study findings are promising, as it seems that those who might benefit most from environmental interventions to promote physical activity, may mainly be adults at risk of being insufficiently active or those difficult to reach through individual health promotion programs. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
[Show abstract][Hide abstract] ABSTRACT: We examined the associations of educational attainment and area socioeconomic status (SES) with total within-neighborhood walking patterns and percentage of walking undertaken for recreation purposes in Hong Kong elders. Environmental mediators of these associations were also examined.
Chinese-speaking elders (N = 484), cognitively unimpaired and able to walk unassisted, were recruited from 32 street blocks stratified by SES and walkability. Interviewer-administered surveys were conducted to collect data on walking and sociodemographics. Neighborhood environments were audited.
Educational attainment was positively related to walking outcomes, while area SES was only positively related to percentage of walking allocated to recreational purposes. While no mediators of area SES-walking associations were identified, several environmental attributes explained the associations of educational attainment with walking.
Educational attainment rather than area SES is a key determinant of walking in Hong Kong elders; these effects are mostly attributable to social and individual rather than environmental factors.
Journal of Aging and Health 11/2013; · 1.56 Impact Factor