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Understanding the relationships between the physical environment and physical activity in older adults: a systematic review of qualitative studies

Abstract (provisional)

Background: 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.

Methods: A systematic search was conducted in databases of various disciplines, including: health, architecture and urban planning, transportation, and interdisciplinary databases. From 3,047 articles identified in the initial search, 31 articles published from 1996 to 2012 met all inclusion criteria. An inductive content analysis was performed on the extracted findings to identify emerging environmental elements related to older adults' PA. The identified environmental elements were then grouped by study methodologies [indoor interviews (individual or focus groups) vs spatial methods (photo-voice, observations, walk-along interviews)].

Results: This review provides detailed information about environmental factors that potentially influence older adults' PA behaviors. These factors were categorized into five themes: pedestrian infrastructure, safety, access to amenities, aesthetics, and environmental conditions. Environmental factors especially relevant to older adults (i.e., access to facilities, green open spaces and rest areas) tended to emerge more frequently in studies that combined interviews with spatial qualitative methods.

Conclusions: Findings showed that qualitative research can provide in-depth information on environmental elements that influence older adults' PA. Future qualitative studies on the physical environment and older adults' PA would benefit from combining interviews with more spatially-oriented methods. Multidisciplinary mixed-methods studies are recommended to establish quantitative relationships complemented with in-depth qualitative information.

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Alex’s Notes: I have talked often about children and adolescents with regard to physical activity, but only 40% of those aged over 65 years of age met the recommended aerobic activity guidelines or strength training guidelines, with only 12% accomplishing both. For clarity, the government recommendations include 150 minutes of moderate or 75 minutes of vigorous aerobic activity per week in addition to two days per week of full-body strength training. Yes promoting the fitness of our future (children) is critical, but maintaining the youth of our past (elderly) is also vitally important. The review at hand illustrates the barriers and promoters of physical activity in older adults from an environmental standpoint.

Overall, 31 studies were reviewed, and give environmental themes emerged as critical in older adult activity levels: pedestrian infrastructure, safety, access to facilities, aesthetics, and environmental conditions. To keep things simple, I summarized the results below.

Theme

Promotes Activity

Deters Activity

Pedestrian Infrastructure

Sidewalks

Handrails

Proper sidewalk maintenance

Separation of walking and cycling paths

No sidewalks

Abrupt endings of sidewalks

Parking lots

Steep gradients

Cracked, uneven, or high curbs

Temporary obstacles

Safety

Street lighting

Tidy

Families w/ children

Friendly & smiling people

Socially responsible residents

Others walking, biking, jogging

Senior patrol

Police & security

Public facility staff

Vacant houses

Overgrown lots

Vandalism

Desolate streets

Poor lighting

Large crowds

Intimidating groups of youth, beggars, immigrants, & homeless people

Access to Facilities

Senior-oriented group activities

Indoor gyms

Indoor pools

Senior-dedicated buildings

Green open space

Daily destinations to promote walking such as stores, mailboxes, libraries, etc.

Public transit

Sheltered bus stops

Easy to sit benches

Public washrooms

Not enough facilities for older adults

Existing facilities too far away

Lack of transportation

High cost of use

Exercising w/out instruction

Aesthetics

Socially responsible residents

Well-kept homes & gardens

Historical buildings

Attractive streetscapes

Nature

Neglected areas such as vacant houses, overgrown lots, fallen trees/branches, or weeds

Environmental Conditions

Warm weather

Quiet/peaceful environment

Fresh air

Cold weather

Hot weather

Wind, ice, snow, rain, darkness

Humidity

Strong sun

Pollution

Traffic

Noise

It is clear from the above list that in order to promote elderly physical activity both in exercise facilities and outdoors, environments should provide high-quality pedestrian infrastructure, be safe from crime and traffic, provide easy access to exercise opportunities, daily destinations, and rest areas, be aesthetically appealing, and provide a pleasant nature-based experience. I believe these are traits we would all like to experience, so next time you are on a walk or in your garden, do something to make the place a little more pleasant. We will all win that way.

 
 

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