Neighborhood walkability and physical activity among older women: Tests of mediation by environmental perceptions and moderation by depressive symptoms

Abstract

Features that enhance neighborhood walkability (higher population density, street connectivity and access to destinations) are associated with higher levels of physical activity among older adults. The perceived neighborhood environment appears to mediate associations between the objective built environment and physical activity. The role of depressed mood in these associations is poorly understood. We examined the degree to which depressive symptoms moderated indirect associations between the objective neighborhood environment and physical activity via the perceived neighborhood environment in older women. We analyzed data on 60,133 women (mean age = 73.1 ± 6.7 years) in the U.S. Nurses' Health Study cohort who completed the 2008 questionnaire. Self-reported measures included the Geriatric Depression Scale, perceived presence of recreational facilities, retail destinations, sidewalks, and crime, and participation in recreational physical activity and neighborhood walking. We created an objective walkability index by summing z-scores of intersection and facility counts within 1200-meter residential network buffers and census tract-level population density. We used multiple regression with bootstrap-generated 95% bias-corrected confidence intervals (BC CIs) to test for mediation and moderated mediation. Objective walkability was associated with 1.99 times greater odds of neighborhood walking (95% BC CI = 1.92, 2.06) and 1.38 times greater odds of meeting physical activity recommendations (95% BC CI = 1.34, 1.43) via the perceived neighborhood environment. These indirect associations were weaker among women with higher depressive symptom scores. Positive associations between objective neighborhood walkability and physical activities such as walking among older women may be strengthened with a reduction in their depressive symptoms.

Influences of Built Environment with Hilly Terrain on Physical Activity in Dalian, China: An Analysis of Mediation by Perceptions and Moderation by Social Environment

“…Objectively assessed environment and perceived environment were related, that is, a higher objective walkability score was associated with a higher perceived neighborhood environment score which, in turn, was associated with higher odds of meeting physical activity recommendations [20]. However, our results showed that only land use mix and construction year was significant, albeit inconsistently, correlated with perceived neighborhood environment score.…”

“…However, few studies have demonstrated the mediation and moderation effect of neighborhood environment and physical activity relations. Research has documented that the association between the number of parks and moderate and vigorous physical activity was mediated by its perceived indicator [19], facility count and population density were associated with neighborhood walking and physical activity via the perceived neighborhood environment [20]. While, the association between built environment and physical activity varies according to the individual socioeconomic backgrounds, such as gender, age, and education, but there is no consistency [21][22][23].…”

Measuring the association of objective and perceived neighborhood environment with physical activity in older adults: challenges and implications from a systematic review

“…At the NE level, objectively measured walkability [ 148 ], a Walkscore [ 126 ], buffer sizes [ 137 ] and primary type of buildings in the neighborhood [ 145 ] were assessed. However, the majority of studies (n = 19) examined self-reported features such as mental health status [ 127 , 131 ], perceived PA [ 40 , 125 , 127 ], perception of crime and safety [ 145 – 147 ], perceived NE [ 130 , 131 ], social cohesion/support [ 127 , 132 , 144 , 146 ], health/medical condition or functional limitations [ 132 , 149 ], self-efficacy [ 132 ], perceptions of proximity [ 153 ] and self-reported park visits [ 40 ]. Potential influencing factors for the perception of the NE, such as driving status [ 82 , 145 ], objective walkability [ 126 , 148 ], individual-level demographics and income [ 121 , 126 , 148 ], dogs in household [ 126 ], as well as body mass index (BMI) [ 126 ] were also included as moderator variables.…”

The Impact of Health Consciousness on the Association Between Walking Durations and Mental Health Conditions After a Disaster: a Cross-Sectional Study

“…The current study indicated a significant negative association between walking durations and depressive symptoms in post-disaster settings, which endorsed the positive effect of walking on mental health conditions seen in previous studies conducted in ordinary settings [ 16 – 22 ]. Multi-level meta-analyses have shown that walking, as well as other physical activities, is positively associated with mental health [ 16 ], and several interventions that encourage moderate levels of walking or increased physical activities have been shown to reduce depressive symptoms [ 17 – 19 ]. A national study of young adults revealed that taking more than 7500 steps per day was associated with fewer depressive symptoms [ 20 ].…”

“…In ordinary settings, general physical activities [7][8][9][10][11][12][13][14][15][16], including walking [17][18][19][20][21][22], are positively associated with mental health and well-being and negatively associated with depressive symptoms regardless of age and gender. However, the relationship between physical activities and mental health conditions has not been well characterized in post-disaster settings with an exception which surveyed the area affected by the GEJE and found that decreased physical activity was significantly associated with increased levels of depressive states among elderly people aged ≧ 65 [23,24].…”