The Neighbourhood Physical Environment and Active Travel in Older Adults: A Systematic Review and Meta-Analysis

Abstract

Background Perceived and objectively-assessed aspects of the neighbourhood physical environment have been postulated to be key contributors to regular engagement in active travel in older adults. We systematically reviewed the literature on neighbourhood physical environmental correlates of active travel in older adults and applied a novel meta-analytic approach to statistically quantify the strength of evidence for environment - active travel associations. Methods Forty two quantitative studies that estimated associations of aspects of the neighbourhood built environment with active travel in older adults (aged ≥ 65 years) and met selection criteria were reviewed and meta-analysed. Findings were analysed according to five active travel outcomes (total walking for transport, within-neighbourhood walking for transport, combined walking and cycling for transport, cycling for transport, and all active travel outcomes combined) and seven categories of the neighbourhood physical environment (residential density/urbanisation, walkability, street connectivity, access to/availability of services/destinations, pedestrian and cycling infrastructure, aesthetics and cleanliness/order, and safety and traffic). Results Most studies examined correlates of total walking for transport. A sufficient amount of evidence of positive associations with total walking for transport was found for residential density/ urbanisation, walkability, street connectivity, overall access to destinations/services, land use mix, pedestrian-friendly features and access to several types of destinations. Littering/vandalism/decay was negatively related to total walking for transport. Limited evidence was available on correlates of cycling and combined walking and cycling for transport, while sufficient evidence emerged for a positive association of within-neighbourhood walking with pedestrian-friendly features and availability of benches/sitting facilities. Correlates of all active travel combined mirrored those of walking for transport. Positive associations were also observed with food outlets, business/ institutional/ industrial destinations, availability of street lights, easy access to building entrance and human and motorised traffic volume. Several but inconsistent individual- (e.g., gender and age) and environmental-level moderators (e.g., signs of crime, sloping streets) of associations were identified. Conclusions Results support strong links between the neighbourhood physical environment and older adults’ active travel. Future research should focus on the identification of types and mixes of destinations that support active travel in older adults and how these interact with individual characteristics and other environmental factors. Future research should also aim to clarify dose-response relationships through multi-country investigations and data-pooling from diverse geographical regions.