Effects of the Rural Built Environment on Physical Activity Stephanie S. Frost, MAOM R. Turner Goins, PhD Department of Community Medicine Center on Aging West Virginia University

Physical Activity and Health Reduces risk of cardiovascular disease (CVD), hypertension, obesity, breast cancer, colon cancer Helps manage arthritis, type 2 diabetes, and cognitive function

Why Rural? Higher rates of CVD, cancer, arthritis, and diabetes Higher rates of physical inactivity Lower % meeting physical activity (PA) recommendations Greater proportions of older adults Percentage of older adults in rural areas may triple by 2010 – aging in place in the non metro pop will triple from 6% (2000’s) to 18% in (2010’s)

Transportation Research Board Built Environment Robert Wood Johnson Foundation Recreational resources Land use characteristics Neighborhood form Community environment Transportation Research Board Land use patterns Transportation systems Design TRB: (1) Land use refers to spatial distribution of human activities. (2) Transportation system refers to physical infrastructure and connectivity b/n activities. (3) Design refers to aesthetics, physical and functional qualities. RWJ: 4 areas. Recreational resources, land use characteristics, neighborhood form, and community environment. (1) Recreational resources= trails, parks and open spaces (part of the outdoor community and not private or public indoor community). (2) Land use = residential and employment density, street connectivity, proximity of destinations. (3) Neighborhood form = availability of sidewalks or streetlights. (4) Community environment = aesthetics, cleanliness, traffic, crime safety, community support or cohesion.

Physical Activity and Built Environment Urban and Suburban Studies Pleasant scenery (+) Safety (+) Walkable destinations (+) Presence of sidewalks (+) Light Traffic (+)

Specific Aims 1. Determine the current state of scientific literature 2. Examine how the built environment in rural areas has been evaluated 3. Consider how the rural built environment effects older adults engaging in physical activity

Current Literature Findings

Methods Identified through Pubmed, Google scholar, Web of Science Inclusion Criteria 2000-2007 Rural sample Assessed relationship between 1 or more element of built environment (BE) and physical activity Quantitative, Qualitative, and Objective Exclusion Criteria No measure of built environment Descriptive only Reliability studies Intervention studies 2000-2007: Studies looking at environment and physical activity emerge in 2000 gordon-larsen Determinants of adolescent physical activity and inactivity patterns. Baker 2000 Measuring the determinants of physical activity in the community: current and future directions.

Results 18 studies 15 quantitative and 3 qualitative 18 cross-sectional Sample Sizes Quantitative n = 274 – 2,338 Qualitative n = 26 – 44 Data Collection Self report Focus group Objective

Results Rural only n = 15 14 random and 4 convenience samples 14 telephone / 4 in-person 17 U.S. / 1 Canadian 7 states 7 provided discussion of parameters used to define rural

How the Built Environment in Rural Areas Has Been Evaluated

Evaluation of Rural BE

+ - Strengths of Evidence Strong Moderate Weak None Malls x Aesthetics Destinations Trails Unattended Dogs Parks Street light Safe from crime Traffic - Sidewalks Rec. facility Malls – nothing signif found. Aesthetics: Not pleasant, nothing to look at + for obese and inactive. 1)Pleasant, 2)interesting to look at, 3) well maintained, 4) garbage free: + regular PA among rural diabetics. Lack of scenery + No LTPA. Many places to walk nearby – assoc with regular PA among diabetics. Association (adjusted) b/n few destinations in walking distance and obese/inactive. Trails: presence NS; use, length, proximity + with activity. Study that didn’t find assoc with trails asked if was where – normally completed PA and was national sample. Parks use and proximity associated with PA but not in national study or in older adult study. Not using – assoc with not meeting reg walking standards. White women reporting “fair” street lighting and AA women reporting very good street lighting were less likely to be active when compared with those that reported poor street lighting. Reporting safe place + assoc with PA for diabetics, whites, older adults. No safe place = more likely to be obese and inactive. Safe from traffic assoc PA for older adults, diabetics. Moderate traffic (compared to heavy) more likely to be reg walker. Not safe from traffic more likely to be obese and inactive; women earning more than 25k – assoc not meeting PA recommendations. Sidewalks associated irregular walking; assoc meeting PA rec for low SES and older adults; shoulders on street assoc PA.

Qualitative Results Barriers Motivators Traffic, safety, lack of sidewalks, facilities, transportation, unattended dogs, and travel distance Motivators Presence of facilities, paved roads

Built Environment and Rural Older Adults

Older Adults Qualitative studies Quantitative 3 qualitative 1 mixed methods Quantitative 1 = age 50+ sample 1 = age 40+ sample

Qualitative Findings Barriers Lack of… Presence of… Indoor facilities Programs/age appropriate classes Transportation Senior centers Presence of… Uneven surfaces Dogs Traffic Travel distance to facilities

Qualitative Findings Confounding variables Health status Fear of injury Weather/Climate

Quantitative Findings Physical Activity Scale for the Elderly No leisure time physical activity Safety from crime + NS Sidewalks Traffic Lights Dogs Park N/A Scenery Access to facilities

Conclusions Strengths Weaknesses Different sub-groups studied Random selection Use of subjective and objective Examine neighborhood, community, and county data Weaknesses Only cross sectional studies Few older adult Select areas represented Definition of rural not enforced Repeated sample (11 samples for 18 studies)

Future Research Longitudinal studies Objective Older adult focus Built environment Physical activity Additional rural locations Rural definition stated Older adult focus Barriers Mediators Consistent physical activity measures Chronic disease

Acknowledgements The project was supported in part by the Centers for Disease Control and Prevention (Healthy Aging Research Network, 5 U48 DP000052)