1. 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

2. 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

3. 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)

4. 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.

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

6. 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

7. Current Literature Findings

8. Methods Identified through Pubmed, Google scholar, Web of Science
Inclusion Criteria
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
: 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.

9. 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

10. 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

11. How the Built Environment in Rural Areas Has Been Evaluated

12. Evaluation of Rural BE

13. + - 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.

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

15. Built Environment and Rural Older Adults

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

17. 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

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

19. 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

20. 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)

21. 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

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