Walk Score Research Articles

Association between community walkability and hypertension: Evidence from the Wuhan Chronic Disease Cohort Study

While community walkability is recognized as a key environmental factor for health status, evidence linking it specifically to hypertension is rather limited. To fill the knowledge gap, we concluded a cross-sectional study among 6421 eligible participants from the Wuhan Chronic Disease Cohort. A well-developed algorithm was performed to evaluate community walkability across Wuhan, quantified as Walk Score. We then calculated each participant residential Walk Score using the geographic information system. The logistic and linear regression models were conducted to determine the relationship between walkability, hypertension and blood pressure, respectively. We further performed the mediation analysis to explore potential mechanisms. After adjusting for extra confounders, we observed a higher community walk score was associated with a lower hypertension risk (OR = 0.73; 95% CI: 0.63, 0.84), a lower systolic blood pressure (β = −3.152 mmHg; 95% CI: −4.25, −2.05), a lower diastolic blood pressure (β = −2.237 mmHg; 95% CI: −2.95, −2.53) and a lower mean arterial pressure (β = −2.976 mmHg; 95% CI: −3.75, −2.20). The effect of community walkability on hypertension was partially mediated by body fat rate. Our study indicates a positive correlation between high walkability and a reduced odds of hypertension in China. This highlights the potential role of urban design in hypertension prevention, emphasizes the need for walkability-focused planning strategies to foster healthier communities, and guides future interventions and research to mitigate hypertension.

Save A Leg – Exploring Disparities in Community Characteristics Between Regions of High and Low Leg Amputation Rates

ObjectiveTo explore the disparities in community characteristics between the regions with the highest and lowest leg amputation rates. ApproachThis study used an exploratory method to describe the disparities between community characteristics of these two regions. The study team used several data sources: 1) We used the Dartmouth Atlas Healthcare Map to identify the highest and lowest leg amputation areas. This data was based on leg amputations per 1,000 Medicare enrollees by Hospital referral regions (HRRs) in 2015. 2) We used population estimates and income data from The Census Bureau. 3) We gathered climate, crime index, walk score, bike lanes, and park data from numerous websites. ResultsFlorence, SC has the highest leg amputation rate and Bridgeport, CT has the lowest across the nation. Florence also shows higher cardiovascular disease and diabetes discharge rates. Florence’s population has a slightly higher percentage of persons 65 years and over, a higher percentage of bachelor’s degrees, a higher per capita income, and a lower poverty rate. Florence also has fewer parks, is less walkable or bikeable, and has worse crime. It is worth noting that Bridgeport is close to Yale New Haven Hospital, which has a Limb Preservation Program that could contribute to the region’s extremely low leg amputation rate. ConclusionsThere are disparities in community characteristics between the regions with the highest and lowest leg amputation rates. ImplicationsFuture work needs to investigate the association between community characteristics and leg amputation rates and assess the impact of the Limb Preservation Program.

The relationships between the campus built environment and walking activity

Despite the gradual development of students’ sedentary habits and associated health problems, only a few studies have extensively and systematically measured campus built environments (CBE) and their impact on street walking activity. This study explores the association between CBEs and pedestrian volume (PV). Comprehensive questionnaires, field audits, and GIS were used to measure the CBE variables and PV of 892 street segments on eight Chinese campuses in Tianjin. We used negative binomial regression models without spatial autocorrelations to investigate the relationship between the CBEs and PV. The findings indicated that campus Walk Score, facility and residential land ratio, campus design qualities, sidewalk conditions, street amenities, and other streetscape features were positively associated with PV. This study presents implications for campus research and planning practices in designing a pedestrian-friendly, sustainable, and healthy campus.

Prognostic Impact of Each Item of the SARC-F Questionnaire in Patients Undergoing Major Surgery for Urologic Cancer.

We aimed to evaluate the association between scores on each item of the SARC-F questionnaire and life expectancy in patients undergoing major surgery for urologic cancer. This retrospective study included 1018 patients undergoing elective major urologic cancer surgery. All patients completed the SARC-F questionnaire preoperatively. Demographic and clinical data were collected. The primary endpoint was an association between SARC-F scores and overall survival (OS). Of the 1018 patients, the median age was 72 years and 920 (90%) were male. Multivariate analysis revealed four factors significantly and independently associated with shorter OS: assistance with walking score ≥1 (Hazard ratio: HR=2.18, P=0.044), cancer stages ≥ III (HR=7.98, P<0.001), high blood loss ≥78 ml or blood transfusion during surgery (HR=4.53, P=0.007 and HR=2.41, P=0.037, respectively). This study found that among the items of the SARC-F questionnaire, assistance with walking was a strong predictor of life expectancy. Incorporating such a simple screening tool into the preoperative assessment would help to ensure more appropriate perioperative care for urologic cancer patients.

Muscle function, exercise capacity, physical activity level and cardiovascular disease risk factor knowledge in patients with prolactinoma.

Prolactinoma can increase the risk of cardiovascular diseases (CVDs), such as arterial stiffness, atherosclerosis, dysrhythmia and heart failure. This study aimed to evaluate and compare muscle function, exercise capacity, physical activity (PA) level, CVD risk factor knowledge level, sleep quality, fatigue and quality of life between prolactinoma patients and healthy controls. Nineteen female patients with prolactinomas and 19 healthy women were included in this study. Quadriceps muscle strength (QMS) was measured using a hand dynamometer, and muscular endurance was evaluated via the squat test. The 6-minute walking test (6MWT) distance was also measured. CVD risk factor knowledge levels were evaluated with the Cardiovascular Diseases Risk Factors Knowledge Level Scale (CARRF-KL), PA levels were assessed with the International Physical Activity Questionnaire-short form (IPAQ), sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI), fatigue was assessed with the Multidimensional Fatigue Rating Scale (MAF), and quality of life was assessed with the Short Form-36 questionnaire (SF-36). Patients with prolactinomas had significantly lower 6MWT distances; CARRF-KL total scores; SF-36 general health and physical limitation scores; and higher IPAQ-sitting scores than did healthy controls (p < 0.05). Moreover, there were no significant differences between the groups in terms of QMS score; number of squats; severity of IPAQ score; severity, moderate, or total walking score; total PSQI score; or total MAF score (p > 0.05). Exercise capacity and quality of life are adversely affected, and sedentary behavior is observed in prolactinomas. Patients with prolactinomas have less knowledge about CVD risk factors than healthy individuals. CVD incidence and knowledge and functional capacity should be improved in patients with prolactinomas by the use of a multidisciplinary team for cardiac rehabilitation. This study is part of a larger clinical trial registered on ClinicalTrials.gov prior to participant enrollment (NCT05236829).

Examination of the Effects of Pilates Exercises on Sleep Quality and Physical Activity.

In this study, it was aimed to examine the effects of pilates exercises applied to university students for 8 weeks on physical activity and sleep quality scores. Forty students (20 female, 20 male) studying at Nevşehir Hacı Bektaş Veli University voluntarily participated in the study. Individuals participating in the study were administered the International Physical Activity Assessment Questionnaire (IPAQ); short form and the Pittsburgh Sleep Quality Index (PSQI) as well as personal information forms including demographic variables. Then, the experimental group practiced Pilates exercises for 8 weeks, 2 days a week, 60 minutes a day, and the training and measurement process was completed by retaking the information obtained as pre-tests through the forms. In the analysis of the data, the normality test was evaluated with Kolmogorov Smirnov and Shapiro-Wilks tests, and Pearson correlation analysis was used for the relationships between variables with normal distribution. Independent Sample T Test was used to compare variables. Confidence interval was 95% and values below p&amp;lt;0.05 were considered significant. According to the analysis results of the participants, it was determined that there were significant differences in favor of the experimental group in the Sleep Quality score (p=,041), Physical Activity total (p=,000) score and physical activity sub-dimensions (High, Medium, Walking) scores of 8-week pilates practices applied to university students. In addition, there was a moderate (r=637) positive correlation between total physical activity score and physical activity sub-dimensions. As a result, regular pilates exercises provided statistically significant differences in sleep quality, physical activity total score and physical activity sub-dimensions and increased the daily physical activity level in participants with a sports background. In the light of these results, we can recommend pilates exercises to increase physical activity level and sleep quality.

Correlation of the Walk Score and Environmental Perceptions with Perceived Neighborhood Walkability: The Quantile Regression Model Approach

The walk score, which is widely used as an index of walkability, does not include pedestrian’s perception, so there is a limit to explaining the level of perceived walkability in a neighborhood. The purpose of this study is to examine how an objectively measured walk score and subjectively measured environmental perceptions correlate with perceived neighborhood walkability. This study conducted a survey on 371 participants aged 18 or older living in Daegu, South Korea to examine perceived neighborhood walkability and perception of the built environment. We measured the walk score based on participants’ location using a geographic information system. We used the quantile regression model, whereby we investigated the effects of explanatory variables (e.g., the walk score, perceptions of the built environment) by classifying perceived neighborhood walkability by quantile into Q10, Q25, Q50, Q75, and Q90. The walk score had a positive association with people with low perceived neighborhood walkability (Q10), but a negative association with people with high perceived neighborhood walkability (Q90). Regarding views of the built environment, in most quantiles, people perceived the environment as walkable if there were abundant green spaces and diverse alternative routes. Conversely, odors, smoke, hills, and stairs impeded walkability. This indicates that along with an objective walkability index, perceptions of the built environment play an important role in determining perceived neighborhood walkability. This implies that our results can help identify appropriate policies to promote walkability for citizens.

Relationship between Improvement in Physical Activity and Three Nutritional Assessment Indicators in Patients Admitted to a Convalescent Rehabilitation Ward.

We investigated the relationship between three nutritional indicators, the Mini Nutritional Assessment-Short Form (MNA-SF), Geriatric Nutritional Risk Index (GNRI), and Controlling Nutrition Status (CONUT), and physical activity at discharge in patients admitted to convalescent rehabilitation wards. The study included 1601 patients (77 ± 12 years, male 46.2%) discharged from convalescent rehabilitation wards between April 2018 and September 2023. MNA-SF, GNRI, and CONUT scores were obtained on admission. Patients were divided into two groups according to their level of Functional Independence Measure (FIM) walk score at discharge. The walking group (n = 1181, FIM walk score ≥ 5, 76 ± 13 years, male 47.2%) was significantly younger than the wheelchair group (n = 420, 79 ± 12 years, FIM walk score < 5, male 43.8%) and had significantly higher MNA-SF (6.5 ± 2.5 vs. 4.7 ± 2.4) and GNRI (93.1 ± 12.4 vs. 86.7 ± 10.9) scores and significantly lower CONUT (3.1 ± 2.3 vs. 3.9 ± 2.3) scores than the wheelchair group (all p < 0.01). Multivariate logistic regression analysis showed that age, handgrip strength, Functional Oral Intake Scale, and MNA-SF score were independently associated with walking ability at discharge (all p < 0.01). In addition, MNA-SF scores were independently associated with Rehabilitation Effectiveness. These results suggest that nutritional status, particularly MNA-SF scores on admission, is associated with improvement of physical activity at discharge.

Health Locus of Control and Physical Activity in Liver Transplant Recipients.

Health locus of controlhas the potential to influence health behavior among individuals with chronic diseases. However, little is known regarding the relationship between locus of control and physical activity in transplant recipients. The aim of the study was to investigate health locus of control and physical activity in liver transplant recipients. Seventy-six liver transplant recipients were enrolled. The Multidimensional Health Locus of Control - Form C, including internal, chance, doctors, and powerful others subdimensions, was used to evaluate the health locus of control. Physical activity was assessed with the International Physical Activity Questionnaire - Short Form. The median internal health locus of control score was 28.54. Thirty-six participants had low, 35 participants had moderate, and five participants had high physical activity. Internal health locus of control was higher in patients having moderate activity compared to patients with low activity (p=0.04). "Doctors" subdimension of health locus of control was negatively correlated with walking (r=-0.38, p=0.02) and total activity scores among patients with low activity (r=-0.37, p=0.02). Liver transplant recipients with moderate activity present higher internal health locus of control scores, suggesting a possible influence of physically active behavior on the beliefs of one's own control over disease management. As the activity level increases, the belief that health outcomes are largely the responsibility of health professionals decreases among liver transplant recipients with low activity. Promoting physical activity will help develop the control of one's own actions on health after liver transplantation.

Self-perceptions of aging, physical activity, and depressive symptoms in older community residents with varied neighborhood walkability in Taiwan

BackgroundPrior research has identified the mediating effect of physical activity in the relationship between self-perceptions of aging and physical health. However, this impact on mental health is unknown, and the influence of environmental contexts proposed by ecological models in this regard remains largely unexplored. Therefore, this study aimed to investigate the role of physical activity in the relationship between self-perceptions of aging and depressive symptoms in older adults, and compare the impact across four levels of neighborhood walkability.MethodsA sample of 1,055 community-dwelling older adults aged 65 or above was obtained through random-digit-dialing computer-assisted telephone interviewing. The individual’s neighborhood walkability was calculated using Walk Score®, and categorized into four levels: car-dependent, somewhat walkable, very walkable, and walker’s paradise. Partial least squares structural equation modelling was employed.ResultsWe found that more positive self-perceptions of aging were associated with fewer depressive symptoms and a mediation effect of physical activity in this relationship. Among the four levels of neighborhood walkability, the mediation effect of physical activity was only statistically significant in the lowest level (car-dependent). The findings supported our hypotheses regarding the mediating effect of self-perceptions of aging on depressive symptoms via physical activity. Neighborhood walkability might potentially influence the mediating role of physical activity.ConclusionsThis study emphasizes key areas on intervention programs and policy formulation to promote mental health in older adults.

Predictors of Physical Activity One Year After Moderate to Severe Traumatic Brain Injury.

To identify predictors of moderate to vigorous physical activity (MVPA) at 12-months post-moderate-severe traumatic brain injury (TBI). Setting: Four inpatient rehabilitation centers. Individuals enrolled in the TBI Model Systems with moderate to severe TBI, admitted to inpatient rehabilitation, and able to ambulate without physical assistance from another person. Prospective longitudinal cohort study. MVPA was measured by having participants wear an ActiGraph GT3X on their wrist for 7 consecutive days. We used multivariate regression to predict minutes per week of MVPA at 12months after TBI. Three classes of predictors were entered hierarchically-demographic and clinical variables (age, sex, body mass index, education, TBI severity, neighborhood walkability score, and self-reported preinjury physical activity [PA] level), baseline TBI-related comorbid conditions (eg, measures of sleep, pain, mood, fatigue, and cognition), and intention to exercise and exercise self-efficacy assessed approximately 1week after discharge from inpatient rehabilitation. 180 participants (ages 17.7-90.3years) were enrolled, and 102 provided at least 5days of valid accelerometer data at 12months. At 12months, participants recorded an average of 703 (587) minutes per week of MVPA. In univariate and multivariate analyses, age was the only significant predictor of 12-month MVPA (r =-0.52). A sharp decline in MVPA was observed in the tertile of participants who were over the age of 61. Older adults with TBI are at elevated risk of being physically inactive. Assuming PA may enhance health after TBI, older adults are a logical target for prevention or early intervention studies. Studies with longer outcomes are needed to understand the trajectory of PA levels after TBI.

Unraveling the Dynamic Relationship between Neighborhood Deprivation and Walkability over Time: A Machine Learning Approach

Unraveling the Dynamic Relationship between Neighborhood Deprivation and Walkability over Time: A Machine Learning Approach

Neighborhood Walkability Is Associated With Lower Burden of Cardiovascular Risk Factors Among Cancer Patients

BackgroundModifiable cardiovascular risk factors constitute a significant cause of cardiovascular disease and mortality among patients with cancer. Recent studies suggest a potential link between neighborhood walkability and favorable cardiovascular risk factor profiles in the general population. ObjectivesThis study aimed to investigate whether neighborhood walkability is correlated with favorable cardiovascular risk factor profiles among patients with a history of cancer. MethodsWe conducted a cross-sectional study using data from the Houston Methodist Learning Health System Outpatient Registry (2016-2022) comprising 1,171,768 adults aged 18 years and older. Neighborhood walkability was determined using the 2019 Walk Score and divided into 4 categories. Patients with a history of cancer were identified through International Classification of Diseases-10th Revision-Clinical Modification codes (C00-C96). We examined the prevalence and association between modifiable cardiovascular risk factors (hypertension, diabetes, smoking, dyslipidemia, and obesity) and neighborhood walkability categories in cancer patients. ResultsThe study included 121,109 patients with a history of cancer; 56.7% were female patients, and 68.8% were non-Hispanic Whites, with a mean age of 67.3 years. The prevalence of modifiable cardiovascular risk factors was lower among participants residing in the most walkable neighborhoods compared with those in the least walkable neighborhoods (76.7% and 86.0%, respectively). Patients with a history of cancer living in very walkable neighborhoods were 16% less likely to have any risk factor compared with car-dependent–all errands neighborhoods (adjusted OR: 0.84, 95% CI: 0.78-0.92). Sensitivity analyses considering the timing of events yielded similar results. ConclusionsOur findings demonstrate an association between neighborhood walkability and the burden of modifiable cardiovascular risk factors among patients with a medical history of cancer. Investments in walkable neighborhoods may present a viable opportunity for mitigating the growing burden of modifiable cardiovascular risk factors among patients with a history of cancer.

The development, validation, and application of the campus walk score measurement system

Improving campus walkability can encourage students to walk and may inhibit the development of sedentary lifestyle habits, obesity, diabetes, and other health issues. This study aimed to formulate an optimized campus Walk Score (WS) measurement system that combines students' weekly demand for the use of facilities and unique campus environments. Bivariate correlation analysis and regression models were used to verify this system. The verified system was further applied to assess campus walkability and its influencing factors. The facility weight and walking time were established through questionnaires distributed on eight campuses in Tianjin, China. GIS and field audits were utilized to collect data on the objective built environment (BE), subjective environmental quality variables, and pedestrian volume (PV). Pearson's correlation analysis and Negative binomial regression models without spatial autocorrelation were used to verify the campus WS measurement system. The significant relationships between BE features and overall WS were found. PV was significantly correlated with overall WS and classified WSs. These findings were all found in the overall and three types of campuses. Therefore, our optimized system can be verified. Additionally, the WS was closely associated with facility distribution, planning mode, and other spatial attributes. Based on our results, how our findings can be utilized to promote campus walkability was proposed.

Sociodemographic Characteristics Associated with Higher Numbers of COVID-19 Cases: A Neighbourhood Level Study in Ottawa, Ontario

INTRODUCATION: The complex interplay of the social conditions that one lives in and functions greatly influences the exposure to a certain health condition and the ability to recover from it. Reports on COVID-19 diagnosis, hospitalization and fatality reveal a clear sociodemographic divide with the marginalized communities bearing a disproportionately higher burden of the outcomes. The objectives of this study was to explore the neighbourhoods characteristics associated with higher COVID-19 rates in Ottawa by employing a social determinants of health framework that identifies critical intersections that impact of multi-level determinants of health. METHODOLOGY: This study is based on data on 98 neighbourhoods in Ottawa that were collected from the Ottawa Neighbourhood study (ONS). The outcome variable was COVID-19 rate between March 09, 2020 - January 31, 2021. The independent variables were potentially vulnerable groups, Socioeconomic, neighbourhood, and demographic factors. We used descriptive and logistic regression methods to analyse the data. RESULTS: The neighbourhoods that had relatively high number of rates COVID-19 cases were Hunt Club Park (909), Manor Park (831), Greenboro East (739), Overbrook McArthur (641), and Hunt Club Upper-Blossom Park (619); and the ones with lowest rates were Laurentian (44), Old Ottawa South (31), Richmond (22), Riverside South Leitrim (19), Wateridge Village (5), and Westboro (3). Multivariate regression analysis showed that neighborhood characteristics such as percentage of community health center within a 50m walk, higher population density, higher percentage of people taking public transportation to work, higher percentage of people with no high school diploma, perceived walkability score, low income prevalence, higher percentage of unsuitable housing, &amp;nbsp;households with multiple family, &amp;nbsp;refugee population, new comer during 2011-16, single parent family, and higher percentage of living alone were associated higher odds of above average COVID-19 rates. CONCLUSION: These findings reflect a greater likelihood of COVID-19 infection in the neighbourhoods with poorer socioeconomic and living conditions such as low income, unhealthy housing, and higher population density. Addressing the challenges among the disadvantaged communities may help reduce the higher vulnerability and promote health conditions.

Association of comorbidities with postoperative walking independence in patients with hip fractures: a single-center, retrospective, observational study.

Hip fractures (HFs) are common in the elderly and lead to decreased walking independence. Although comorbidities may be associated with gaining walking independence, few studies have comprehensively examined baseline and preoperative clinical factors. We aimed to evaluate the effects of comorbidities on the postoperative walking independence of patients with HFs. This single-center, retrospective, observational study included patients with HFs admitted to an acute care hospital between 1 May 2022 and 1 March 2023, who before the incident were able to walk independently [functional independence measure (FIM) walk score ≥6 points]. Postoperative walking independence was evaluated using the walk item of the FIM. The Charlson comorbidity index (CCI) was used to evaluate comorbidities at admission, and the patients were divided into two categories with CCI scores of 0 points and ≥1 point. The effect of comorbidities, assessed using the CCI, on postoperative walking independence was evaluated using Cox proportional hazards analysis. Ninety-four participants were included in the analysis. The Cox proportional hazards model adjusted for potential confounders (age, operative delay and nutritional status) revealed that the CCI was significantly associated with postoperative walking independence ( P < 0.05). The hazard ratio and 95% confidence interval (CI) for the CCI for postoperative walking independence were 0.40 (95% CI, 0.189-0.865). Preoperative assessment of comorbidities using the CCI may aid in predicting the postoperative walking independence of patients with HFs.

Physical Activity Levels in Transplant Recipients.

BACKGROUND Physical activity is a key factor in improvement of quality of life. This study aimed to assess the extent of physical activity in solid-organ transplant recipients. MATERIAL AND METHODS The study involved 106 patients, mostly kidney (64.15%) and liver (28.30%) recipients, observed in a Warsaw transplant center. The study group was dominated by women (56.6%), mean age 49.25±14.09 years, the time since transplantation ranged from 1 month to 28 years, with a mean of 93.9±71.83 months. Recipients were educated about physical activity in the immediate post-transplant period and during follow-up visits. The study was conducted in early 2021 and used the long form of the International Physical Activity Questionnaire (IPAQ) validated for Polish patients, consisting of the of 5 parts - physical activity, professional work, travel, housework, recreation, and time spent sitting - containing a total of 27 questions in the main part of the questionnaire and 7 questions in the introductory part determining the typicality of the last 7 days. RESULTS More than half (57.5%) of the transplant recipients reported high levels of physical activity. Patients reported the highest mean physical activity in job-related physical activity (P<0.001). Patients also had high scores for walking and moderate-intensity physical activity, while the lowest mean scores were for leisure-time physical activity, total vigorous-intensity physical activity, and housework-related activity. CONCLUSIONS When undertaking physical activity, patients turn to activities that do not involve intense effort, are less physically demanding, and do not result in high energy expenditure. Employed patients had higher PA levels in all domains.

Association between Built Environment Policy and Good Health Status

ABSTRACT Introduction/Purpose Access to a high-quality built environment may help improve resident health status. However, city-level evidence regarding the health benefits of community assets is lacking. Thus, we aimed to examine the association between environmental indicators of cities and health statuses of residents. Methods This panel study used the American Fitness Index® data reported annually between 2018 and 2022 for the 100 most populous US cities. The study outcome was self-reported good health status of residents, and exposures were environmental factors: parks per 10,000 residents, percentage of walking distance parks, Walk Score®, air quality index, Bike Score®, Complete Streets policy, park expenditure per resident, and physical education requirement. We applied crude and multivariable-adjusted linear mixed and general models in our analyses. Results Among the 100 largest US cities, 84 increased in percentage of good health status from 2018 to 2022, but the increase was at most 13.1%. Furthermore, the maximum percentage with good health status was only between 60% and 70% in most fit cities, and the gap in good health status between most and least fit cities was approximately 40%. Good health status of residents was significantly (in the positive direction) associated with walking distance parks, Walk Score®, Bike Score®, and Complete Streets policy. The baseline percentage for walking distance parks, Walk Score®, and Complete Streets policy were each significantly associated with higher percentages of good health status of residents over the follow-up period. Conclusion Our study shows room for improvement in environments in all cities. Findings furthermore suggest that environmental factors, such as availability of parks within walking distance, walkability, bikeability, and Complete Streets policy, have the potential to impact the general health status of residents of the largest US cities.

Association of neighbourhood walkability and haemoglobin A1c levels among Latino and non-Hispanic White patients with diabetes.

Neighbourhood walkability can benefit cardiovascular health. Latino patients are more likely than non-Hispanic White patients to have diabetes, and evidence has shown better diabetes-related outcomes for patients living in neighbourhoods conducive to physical activity. Our objective was to determine whether neighbourhood walkability was associated with haemoglobin A1c (HbA1c) levels among English- and Spanish-preferring Latino patients compared to non-Hispanic White patients. We used electronic health record data from patients in the OCHIN, Inc. network of community health centres (CHC) linked to public walkability data. Patients included those age ≥ 18 with ≥ 1 address recorded, with a study clinic visit from 2012 to 2020, and a type 2 diabetes diagnosis (N = 159,289). Generalized estimating equations logistic regression, adjusted for relevant covariates, was used to model the primary binary outcome of always having HbA1c < 7 by language/ethnicity and walkability score. For all groups, the walkability score was not associated with higher odds and prevalence of always having HbA1c < 7. Non-Hispanic White patients were most likely to have HbA1c always < 7 (prevalence ranged from 32.8% [95%CI = 31.2-34.1] in the least walkable neighbourhoods to 33.4% [95% CI 34.4-34.7] in the most walkable), followed by English-preferring Latinos (28.6% [95%CI = 25.4-31.8]-30.7% [95% CI 29.0-32.3]) and Spanish-preferring Latinos (28.3% [95% CI 26.1-30.4]-29.3% [95% CI 28.2-30.3]). While walkability score was not significantly associated with glycaemic control, control appeared to increase with walkability, suggesting other built environment factors, and their interaction with walkability and clinical care, may play key roles. Latino patients had a lower likelihood of HbA1c always < 7, demonstrating an opportunity for equity improvements in diabetes care.

Clinical Study of Preoperative Prehabilitation Synchronized Neoadjuvant Chemotherapy for Gastric Cancer Patients

Background. To investigate the effectiveness of prehabilitation in improving physical and nutritional status in patients undergoing gastric cancer resection. Methods. A total of 136 locally advanced gastric cancer patients who planned to undergo neoadjuvant chemotherapy (NAC) plus transabdominal radical surgery were involved. All participants were divided into the prehabilitation group and the control group using the odd-even method, with 68 cases in each group. Intervention consisted of preoperative exercise and nutrition optimization. Participants were adults awaiting elective gastric resection for cancer. The primary outcomes were changes in functional ability and nutritional status, as measured by relative changes in 6 minute walking distance (6MWD) and scores on the albumin and prealbumin. Preoperative (end of the prehabilitation period) and postoperative (from 4 to 6 weeks after surgery) data were compared between the two groups. Results. All 136 patients were randomized in this study. Compared with the control group, the prehabilitation group exhibited improved functional capacity both before surgery (6MWD change) and after surgery. Furthermore, it demonstrated significantly higher levels of albumin and prealbumin before and after surgery than the control group. Conclusion. Prehabilitation in gastric cancer patients can improve preoperative functional capacity and nutritional status. Maintaining a patient’s physical function and nutritional status may have a significant impact on the continuity of cancer care.