Exercise facilities and the prevalence of obesity and type 2 diabetes in the city of Madrid

Luis Cereijo,David Valadés,Usama Bilal,Pedro Gullón,Isabel Del Cura,Hannah Badland,Manuel Franco

doi:10.1007/s00125-021-05582-5

Abstract

Aims/hypothesisWe aimed to study the association between the availability of exercise facilities and the likelihood of obesity and type 2 diabetes in the adult population of Madrid, Spain.MethodsWe analysed the electronic medical records of all 1,270,512 residents of Madrid aged 40–75 years in 2017. Exercise facility availability was defined as the count of exercise facilities in a 1000 m street network buffer around each residential building entrance. Poisson regression with standard errors clustered at census tract level was used to assess prevalence ratios of exercise facility availability tertiles and obesity and type 2 diabetes. We also examined stratified results by tertiles of area-level socioeconomic status (SES) and sex.ResultsPeople living in areas with lower availability of exercise facilities had a higher prevalence of obesity (prevalence ratio [PR] 1.22 [95% CI 1.20, 1.25]) and diabetes (PR 1.38 [95% CI 1.34, 1.43]). We observed effect modification by area-level SES (p<0.001), with stronger associations for residents living in low-SES areas and no association for residents living in high-SES areas. Associations with type 2 diabetes were stronger among women compared with men, while associations with obesity were similar by sex.Conclusions/interpretationPeople living in areas with low availability of exercise facilities had a higher prevalence of obesity and type 2 diabetes, and this association was strongest in low-SES areas and for women. Understanding the potential role of exercise facilities in driving inequities in obesity and type 2 diabetes prevalence may inform interventions to reduce health inequities.Graphical abstract

Highlights

Increased physical activity is linked to reductions in risks of type 2 diabetes and obesity [1,2,3]
Increased physical activity opportunities at the neighbourhood level are associated with lower obesity [12] and type 2 diabetes risk [13]; for example, higher availability of green and open spaces is associated with lower type 2 diabetes prevalence [14, 15] and incidence [16, 17]
A social gradient was evident for type 2 diabetes, whereby type 2 diabetes was more prevalent in lowSES areas (9.1%), compared with medium- (7.1%) and highSES (5.0%) areas, and in men (8.6% compared with 5.8% in women)

Summary

Introduction

Increased physical activity is linked to reductions in risks of type 2 diabetes and obesity [1,2,3]. Increased physical activity opportunities at the neighbourhood level are associated with lower obesity [12] and type 2 diabetes risk [13]; for example, higher availability of green and open spaces is associated with lower type 2 diabetes prevalence [14, 15] and incidence [16, 17]. Higher availability of exercise facilities potentially increases opportunities for structured exercise, which is associated with a lower prevalence of obesity [12] and greater reductions in HbA1c, compared with delivering physical activity advice alone [21]

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