Abstract
BackgroundConverging 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.MethodsParticipants (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.ResultsA 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.ConclusionsHigher 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3603-y) contains supplementary material, which is available to authorized users.
Highlights
Converging international evidence suggests that diabetes incidence is lower among adults living in more walkable neighbourhoods
The following were queried by questionnaire: age, sex, time since diabetes diagnosis, home address, married/ common-law status, university education, employment, ethnicity, immigrant status, dog ownership, smoking status, insulin use, ownership and/or regular access to a motorized vehicle, depressed mood (Center for Epidemiologic Studies-Depression Scale score ≥16) [28], perceived neighbourhood walkability, and the importance of a neighbourhood’s walkability when choosing to move there
Our analyses demonstrate that higher neighbourhood walkability is associated with somewhat higher levels of neighbourhood-based physical activity in adults with type 2 diabetes after adjustment for age, body mass index (BMI), sex, education, season, car access, and residential self-selection
Summary
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. Urban planners consider walkable neighbourhoods to be characterized by a variety of services and destinations accessed through well-connected street networks [8, 9]. These emerge when demand for services is high, as in more densely populated areas [10, 11]. The relationship between neighbourhood walkability and physical activity has not been well-studied in type 2 diabetes, despite evidence of lower diabetes incidence in more walkable neighbourhoods [17, 18]
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