James F. Sallis and Jacqueline Kerr
Oliver J. Webb, Frank F. Eves and Jacqueline Kerr
Stair climbing is an accessible activity with proven health benefits. This article summarizes the effectiveness of mall-based stair-climbing interventions, while controlling for, and examining, potential moderators of stair/escalator choice.
Six comparable studies were identified, which used poster/ banner prompts to promote stair choice. Original data were combined and analyzed using logistic regression. Pedestrians’ stair/escalator choices (N = 127,221) provided the dichotomous outcome variable. Demographics (eg, gender), condition (baseline vs. intervention), and ‘pedestrian traffic volume’ were entered as potential moderators. To examine durability of effects, the rate of stair climbing in each half of the intervention period was compared.
Overall, stair choice was more common in men (odds ratio [OR] = 1.72), under-60s (OR = 1.91), Whites (OR = 1.38), those without accompanying children (OR = 1.53), and periods of high traffic (OR = 1.55). The rate of stair climbing increased in the intervention phase relative to baseline (OR = 2.09), with greater effects among women (OR = 1.99) versus men (OR = 1.86), and under-60s (OR = 2.62) versus over-60s (OR = 1.93). Intervention effects fell slightly during the second half of the intervention period (OR = 0.92).
Conventional mass media campaigns engage an extra 5.0% of people in physical activity. The current calculations indicate that comparatively simple poster/banner prompts can increase stair climbing in mall settings by 6.0%.
Josef Mitáš, Ding Ding, Karel Frömel and Jacqueline Kerr
Post-communist countries have experienced rapid economic development and social changes, which have been accompanied by changes in health-related lifestyle behaviors, such as physical activity. The purpose of this study was to examine the associations of domain-specific physical activity and total sedentary time with BMI among adults in the Czech Republic.
We surveyed a nationally representative sample (n = 4097) of the Czech Republic in fall 2007 using the International Physical Activity Questionnaire (long form). Multiple linear regression analyses were used to examine associations of physical activity, sedentary time and sociodemograhic characteristics with BMI.
Older age, lower educational attainment, and lower levels of leisure-time physical activity were associated with higher BMI. Compared with those living in large cities, men living in small towns and women living in small villages had higher BMI.
This study has identified correlates of BMI in the Czech Republic. Although more evidence from longitudinal studies is needed, findings from the current study can inform interventions to prevent the rising obesity epidemic.
Lawrence Frank, Jacqueline Kerr, Dori Rosenberg and Abby King
Suburban development patterns may impede physical activity (PA) and mobility and affect healthy aging. This paper investigates the relationships between neighborhood design and walking, driving, PA, and obesity in adults over age 65 years.
Data from the SMARTRAQ (Atlanta region) survey provided measures of PA, BMI, SES, and travel patterns. Neighborhood design was measured using a walkability index (residential density, street connectivity, retail density, and land use mix). Chi square and regression was used to evaluate relationships.
Increased walkability was related with more walking (OR 2.02), less time spent traveling in a car (OR .53), and lower odds of being overweight (OR .68). Those with 1 or no cars were more likely to walk (OR 2.9) and spend less time in cars (OR .53); but also less likely to get recommended levels of PA (OR .55). Visiting a fast food outlet was associated with increased odds of obesity (OR 1.81).
Policies are needed to bring older Americans closer to shops and services and healthy food outlets as a means of encouraging regular walking and healthy body weight. Incentives to encourage neighborhood grocery stores and affordable housing in central areas along with regulatory reform through zoning can encourage PA and healthy body weight in the elderly.
Jordan A. Carlson, J. Aaron Hipp, Jacqueline Kerr, Todd S. Horowitz and David Berrigan
Objectives: To document challenges to and benefits from research involving the use of images by capturing examples of such research to assess physical activity– or nutrition-related behaviors and/or environments. Methods: Researchers (i.e., key informants) using image capture in their research were identified through knowledge and networks of the authors of this paper and through literature search. Twenty-nine key informants completed a survey covering the type of research, source of images, and challenges and benefits experienced, developed specifically for this study. Results: Most respondents used still images in their research, with only 26.7% using video. Image sources were categorized as participant generated (n = 13; e.g., participants using smartphones for dietary assessment), researcher generated (n = 10; e.g., wearable cameras with automatic image capture), or curated from third parties (n = 7; e.g., Google Street View). Two of the major challenges that emerged included the need for automated processing of large datasets (58.8%) and participant recruitment/compliance (41.2%). Benefit-related themes included greater perspectives on obesity with increased data coverage (34.6%) and improved accuracy of behavior and environment assessment (34.6%). Conclusions: Technological advances will support the increased use of images in the assessment of physical activity, nutrition behaviors, and environments. To advance this area of research, more effective collaborations are needed between health and computer scientists. In particular development of automated data extraction methods for diverse aspects of behavior, environment, and food characteristics are needed. Additionally, progress in standards for addressing ethical issues related to image capture for research purposes is critical.
Jacqueline Kerr, Greg Norman, Rachel Millstein, Marc A. Adams, Cindy Morgan, Robert D. Langer and Matthew Allison
Few studies of older adults have compared environmental correlates of walking and physical activity in women who may be more influenced by the environment. Environmental measures at different spatial levels have seldom been compared. Findings from previous studies are generally inconsistent.
This study investigated the relationship between the built environment and physical activity in older women from the Women’s Health Initiative cohort in San Diego County (N = 5401). Built environment measures were created for 3 buffers around participants’ residential address. Linear regression analyses investigated the relationship between the built environment features and self-reported physical activity and walking.
Total walking was significantly positively associated with the walkability index (β = .050: half-mile buffer), recreation facility density (β = .036: 1-mile buffer), and distance to the coast (β = –.064; P-values < .05). Total physical activity was significantly negatively associated with distance to the coast and positively with recreation facility density (β = .036: 1-mile buffer; P < .05).
Although effect sizes were small, we did find important relationships between walkability and walking in older adults, which supports recommendations for community design features to include age friendly elements. More intense physical activity may occur in recreational settings than neighborhood streets.
Dori E. Rosenberg, Jacqueline Kerr, James F. Sallis, Gregory J. Norman, Karen Calfas and Kevin Patrick
The authors tested the feasibility and acceptability, and explored the outcomes, of 2 walking interventions based on ecological models among older adults living in retirement communities. An enhanced intervention (EI) was compared with a standard walking intervention (SI) among residents in 4 retirement facilities (N = 87 at baseline; mean age = 84.1 yr). All participants received a walking intervention including pedometers, printed materials, and biweekly group sessions. EI participants also received phone counseling and environmental-awareness components. Measures included pedometer step counts, activities of daily living, environment-related variables, physical function, depression, cognitive function, satisfaction, and adherence. Results indicated improvements among the total sample for step counts, neighborhood barriers, cognitive function, and satisfaction with walking opportunities. Satisfaction and adherence were high. Both walking interventions were feasible to implement among facility-dwelling older adults. Future studies can build on this multilevel approach.
Megan E. Grimstvedt, Jacqueline Kerr, Sara B. Oswalt, Donovan L. Fogt, Tiffanye M. Vargas-Tonsing and Zenong Yin
This study tested the effectiveness of a stair use promotion strategy in visible and hidden stairwells during intervention and post intervention follow up.
A quasi-experimental study design was used with a 1 week baseline, a 3 week intervention, and post intervention at 2 and 4 weeks in 4 university buildings in San Antonio, Texas with stairwells varying in visibility. Participants were students, faculty, staff, and visitors to the 4 buildings. A total of 8431 observations were made. The intervention incorporated motivational signs with direction to nearby stairwells placed by elevators to promote stair use. Stair and elevator use was directly observed and recorded. Logistic regression analyses were used to test whether stair versus elevator use varied by intervention phase and stairwell visibility.
Stair use increased significantly (12% units) during the intervention period and remained above baseline levels during post intervention follow-up. At baseline, visible stairs were 4 times more likely to be used than hidden stairs; however, the increase in stair use during intervention was similar in both types of stairwells.
Motivational and directional signage can significantly increase stair use on a university campus. Furthermore, stairwell visibility is an important aspect of stair use promotion.
Simon Marshall, Jacqueline Kerr, Jordan Carlson, Lisa Cadmus-Bertram, Ruth Patterson, Kari Wasilenko, Katie Crist, Dori Rosenberg and Loki Natarajan
The purpose of this study was to compare estimates of sedentary time on weekdays vs. weekend days in older adults and determine if these patterns vary by measurement method. Older adults (N = 230, M = 83.5, SD = 6.5 years) living in retirement communities completed a questionnaire about sedentary behavior and wore an ActiGraph accelerometer for seven days. Participants engaged in 9.4 (SD = 1.5) hr per day of accelerometer-measured sedentary time, but self-reported engaging in 11.4 (SD = 4.9) hr per day. Men and older participants had more accelerometer-measured sedentary time than their counterparts. The difference between accelerometer-measured weekday and weekend sedentary time was nonsignificant. However, participants self-reported 1.1 hr per day more sedentary time on weekdays compared with weekend days. Findings suggest self-reported but not accelerometer-measured sedentary time should be investigated separately for weekdays and weekend days, and that self-reports may overestimate sedentary time in older adults.
Lilian G. Perez, Terry L. Conway, Adrian Bauman, Jacqueline Kerr, John P. Elder, Elva M. Arredondo and James F. Sallis
Background: Associations between the built environment and physical activity (PA) may vary by sociodemographic factors. However, such evidence from international studies is limited. This study tested the moderating effects of sociodemographic factors on associations between perceived environment and self-reported total PA among adults from the International Prevalence Study. Methods: Between 2002 and 2003, adults from 9 countries (N = 10,258) completed surveys assessing total PA (International Physical Activity Questionnaire-short), perceived environment, and sociodemographics (age, gender, and education). Total PA was dichotomized as meeting/not meeting (a) high PA levels and (b) minimum PA guidelines. Logistic models tested environment by sociodemographic interactions (24 total). Results: Education and gender moderated the association between safety from crime and meeting high PA levels (interaction P < .05), with inverse associations found only among the high education group and men. Education and gender also moderated associations of safety from crime and the presence of transit stops with meeting minimum PA guidelines (interaction P < .05), with positive associations found for safety from crime only among women and presence of transit stops only among men and the high education group. Conclusions: The limited number of moderating effects found provides support for population-wide environment–PA associations. International efforts to improve built environments are needed to promote health-enhancing PA and maintain environmental sustainability.