Abstract
Previous studies have documented numerous health benefits of conducting regular physical activity among older adults. The built environment is believed to be a key factor that can hinder or facilitate daily physical activity, such as walking and exercising. However, most empirical studies focusing on environment-physical activity associations exhibited residential self-selection bias with cross-sectional research design, engendering doubts about the impact of built environment on physical activity. To reduce this bias, we assessed physical activity behaviors of 720 Hong Kong older adults (≥65 years) residing in 24 public housing estates. The Hong Kong public housing scheme currently provides affordable rental flats for 2.1 million people or approximate 30% of total population. The applicants were allocated to one of 179 housing estates largely by family size and flat availability. Built environment characteristics were measured following the ‘5Ds’ principle: (street network) design, (land-use) diversity, density, distance to transit, and destination accessibility. Multilevel mixed models were used to explore the associations between the built environment and the different domains of physical activity (transportation walking, recreational walking, and recreational moderate-to-vigorous physical activity (MVPA) while controlling for potential estate-level socioeconomic and individual confounders. We found that transportation walking was positively associated with the number of bus stops and the presence of Mass Transit Railway (MTR) stations. Recreational MVPA was positively related to the number of recreational facilities. However, land-use mix was negatively related to transportation walking, recreational walking, and recreational MVPA. The findings of this study support a threshold effect in the environment-physical activity associations. Furthermore, large-scale public housing schemes involving random or semi-random residence assignment in many cities may provide opportunities to explore built environments and physical activity behavior, with the potential to overcome residential self-selection bias.
Highlights
Hong Kong and many global cities are facing the challenges of aging populations, with one challenge being an increased demand for healthcare services and expenditure
35.4% of older adults achieved at least 150 min of transportation walking, 58.9% achieved at least 150 min of recreational walking, and 38.5% achieved at least 150 min of recreational moderate-to-vigorous physical activity (MVPA) in one week (Table 2)
The median household income of our participants was lower compared with population-level median income, given that we only sampled older adults living in public housing estates
Summary
Hong Kong is a coastal city in the developed area of China; it features high-density urban development and affordable public housing system. The gross population density of Hong Kong in 2016 was 6603 people per km ; private automobile ownership is only 0.07 per resident [1]. Hong Kong achieved international renown for the large-scale public housing system, which provide inexpensive accommodation for low-income families. 179 public housing estates and a total stock of 0.8 million flats. On average, has 3975 housing flats and 60,000 m2 site area, accommodating 10,832 residents [31]. Public housing estates generally consist of multiple 30- to 40-story residential towers and surrounding public spaces built for physical and leisure activities, often including basketball courts, playgrounds, and elderly fitness centers [32,33] (Figure 1). The housing estate is the smallest census unit in Hong Kong
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