Neighbourhood walkability and home neighbourhood-based physical activity: an observational study of adults with type 2 diabetes

• Published in: BMC public health Vol. 16; no. 1; p. 957
• Main Authors: Hajna, Samantha, Kestens, Yan, Daskalopoulou, Stella S, Joseph, Lawrence, Thierry, Benoit, Sherman, Mark, Trudeau, Luc, Rabasa-Lhoret, Rémi, Meissner, Leslie, Bacon, Simon L, Gauvin, Lise, Ross, Nancy A, Dasgupta, Kaberi
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 09-09-2016; BioMed Central; BMC
• Subjects: Acceleration; Accelerometers; Accelerometry; Adult; Adults; Age; Aged; Body mass index; Body size; Canada; Confidence intervals; Cross-Sectional Studies; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2; Employment; Environment Design - statistics & numerical data; Evaluation; Exercise; Female; Geographic Information Systems; Global Positioning Systems; GPS; Humans; Land use; Linear Models; Male; Middle Aged; Motor ability; Neighbourhood walkability; Observational studies; Physical activity; Physical activity locations; Physiological aspects; Population density; Public health; Regression analysis; Residence Characteristics - statistics & numerical data; Robustness (mathematics); Satellite navigation systems; Studies; Type 2 diabetes; Walking; Environmental epidemiology; Type 2 diabetes; Neighbourhood walkability; Physical activity; Physical activity locations; Global Positioning Systems; Accelerometry; Health geography
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/s12889-016-3603-y

Converging international evidence suggests that diabetes incidence is lower among adults living in more walkable neighbourhoods. The association between walkability and physical activity (PA), the presumed mediator of this relationship, has not been carefully examined in adults with type 2 diabetes. We investigated the associations of walkability with total PA occurring within home neighbourhoods and overall PA, irrespective of location.
Participants (n = 97; 59.5 ± 10.5 years) were recruited through clinics in Montreal (QC, Canada) and wore a GPS-accelerometer device for 7 days. Total PA was expressed as the total Vector of the Dynamic Body Acceleration. PA location was determined using a Global Positioning System (GPS) device (SIRF IV chip). Walkability (street connectivity, land use mix, population density) was assessed using Geographical Information Systems software. The cross-sectional associations between walkability and location-based PA were estimated using robust linear regressions adjusted for age, body mass index, sex, university education, season, car access, residential self-selection, and wear-time.
A one standard deviation (SD) increment in walkability was associated with 10.4 % of a SD increment in neighbourhood-based PA (95 % confidence interval (CI) 1.2, 19.7) - equivalent to 165 more steps/day (95 % 19, 312). Car access emerged as an important predictor of neighbourhood-based PA (Not having car access: 38.6 % of a SD increment in neighbourhood-based PA, 95 % CI 17.9, 59.3). Neither walkability nor car access were conclusively associated with overall PA.
Higher neighbourhood walkability is associated with higher home neighbourhood-based PA but not with higher overall PA. Other factors will need to be leveraged to facilitate meaningful increases in overall PA among adults with type 2 diabetes.