Effects of Enriched Physical Activity Environments on Balance and Fall Prevention in Older Adults: A Scoping Review

in Journal of Aging and Physical Activity

Click name to view affiliation

Mohsen Shafizadeh
Search for other papers by Mohsen Shafizadeh in
Current site
Google Scholar
PubMed
Close
,
Jane Manson
Search for other papers by Jane Manson in
Current site
Google Scholar
PubMed
Close
,
Sally Fowler-Davis
Search for other papers by Sally Fowler-Davis in
Current site
Google Scholar
PubMed
Close
,
Khalid Ali
Search for other papers by Khalid Ali in
Current site
Google Scholar
PubMed
Close
,
Anna C. Lowe
Search for other papers by Anna C. Lowe in
Current site
Google Scholar
PubMed
Close
,
Judy Stevenson
Search for other papers by Judy Stevenson in
Current site
Google Scholar
PubMed
Close
,
Shahab Parvinpour
Search for other papers by Shahab Parvinpour in
Current site
Google Scholar
PubMed
Close
, and
Keith Davids
Search for other papers by Keith Davids in
Current site
Google Scholar
PubMed
Close
Full access

The incidence of falling, due to aging, is related to both personal and environmental factors. There is a clear need to understand the nature of the major risk factors and design features of a safe and navigable living environment for potential fallers. The aim of this scoping review was to identify studies that have examined the effectiveness of environments, which promote physical activity and have an impact on falls prevention. Selected studies were identified and categorized into four main topics: built environment, environment modifications, enriched environments, and task constraints. The results of this analysis showed that there are a limited number of studies aiming to enhance dynamic postural stability and fall prevention through designing more functional environments. This scoping review study suggests that the design of interventions and the evaluation of an environment to support fall prevention are topics for future research.

Aging is complex in nature and is accompanied by physical, sensory perceptual, and cognitive changes in the body that could affect balance and gait in predictable and unpredictable situations (Melzer, Kurz, & Oddsson, 2010). A fall after losing balance and control of upright posture is a common problem in older adults that has increased the cost of hospitalization and falls-related injuries and disabilities (Scuffham, Chaplin, & Legood, 2003). It is estimated that one in three people aged 65 years and older experience a fall at least once a year in the United Kingdom. In the United States, 28.7% of community-dwelling adults aged 65 years and older reported falling, and there were an estimated 33,000 fall-related deaths in 2015 (Bergen, Stevens, & Burns, 2016). Approximately 5% of older people in community-dwelling settings who fall in a given year experience a fracture or require hospitalization, live in community-dwelling settings (Perell et al., 2001).

In older adults, falls have a multidimensional etiology, and the ability to compensate in response to falling is a key determinant for physical rehabilitation (Nyberg & Gustafson, 1995; Rensink, Schuurmans, Lindeman, & Hafsteinsdottir, 2009). Factors such as diminished sensory-motor functions (Dhital, Pey, & Stanford, 2010); neuromusculoskeletal impairments (Daly et al., 2013); deconditioning related to inactivity (Kabeshova et al., 2014); severe pain; sarcopenia; chronic diseases; frailty; and depression (Gale, Cooper, & Aihie Sayer, 2016) have been recognized as significant predictors of a fall incident in older adults.

In recent years, special attention from health care organizations has been paid to effective interventions that prevent the risk of falling or that reduce the fall incident rate in older adults (Public Health England, 2017). There have been a promising number of studies that have examined effects of different interventions on reductions of fall incident rate. Two systematic reviews that included 40 randomized clinical trials between 1992 and 2002 (Chang et al., 2004) and 62 randomized clinical trials between 2016 and 2018 (Guirguis-Blake, Michael, Perdue, Coppola, & Beil, 2018) have demonstrated that a multifactorial program as well as exercise and vitamin D supplementation were effective interventions to reduce the rate of falls incidents in community-dwelling older adults. The multifactorial program included comprehensive geriatric assessments (balance, gait, vision, blood pressure, understanding of environment hazards, cognition, and psychological health); a treatment intervention (supervised/unsupervised exercise, cognitive behavioral therapy, nutrition therapy, medication management, education tutorials, and environment modifications); and a referral to a specialist support team. The most common types of exercise interventions targeted improvements in gait, balance, and provided functional training as a form of individual or group exercise. Occupational therapy practice aims to maintain or create a balance between these elements (Law et al., 1996). A Cochrane review (Gillespie & Handoll, 2009) found that environmental assessment and modification was an effective approach to reduce incidence of falls, and a further review (Clemson et al., 2019) is currently being undertaken because different environmental intervention types, different delivery approaches, may have different effects on falls and fall-related injuries. For example, a large trial (Clemson et al., 2019) suggests that environmental interventions can prevent falls in older adults at high risk of falls, but they have little or no benefit in older adults at low risk of falls (Pighills, Drummond, Crossland, & Torgerson, 2019). Environmental assessment and modification encompasses a comprehensive, validated functional assessment of the individual in their home environment, a joint problem-solving approach, and follow-up as required.

The physical and cognitive dysfunctions could be conceptualized by relational models of disability that emphasize the inclusive and exclusive roles of space/environment to enable or disable the person in his or her daily activities (Hall & Wilton, 2017). In other words, the way that a person perceives the environment could enable him or her to participate in daily activities as it is shown in children with disability in educational environments (Stephens, Ruddick, & McKeever, 2015). The relational perspective on physical (dis)ability and the environment could establish a principle in the provision of physical activity and fall prevention programs so that designing more enabling physical activity environments that could mitigate the performance declines due to aging process is emphasized. Another theory that supports a cyclic interaction between the person and the surrounding environment for action planning is ecological dynamic approach (Fajen & Matthis, 2011). According to this approach, the environment and activities could facilitate the movement organization despite the physical limitations that are experienced due to aging or motor disabilities. The role of perception to the environment in fall prevention could also explain the major limitation in previous interventions that mainly focused on the physical and motor fitness factors (e.g., strength, balance, coordination) instead of the perception of environmental challenges (contextual enabling/limiting factors). These types of intervention lack representativeness due to a mismatch between the types of task activities included in the interventions and the necessary adaptive responses that are required to interact with the dynamic physical environments, such as negotiating gaps, inclines, steps, obstacles, and surfaces in an everyday living environment (Qiu et al., 2012).

The ability to cope with key environmental constraints such as surfaces; barriers; and external objects (size, shape, color, etc.) is an important cognitive–perceptual factor that could affect movement planning (Sánchez, Murillo, Davids, & Hernández, 2016). In addition, the postural adaptations needed in a dynamic environment, due to the presence of physical hazards, demands a continuous perceptual-motor calibration and recalibration (Brand & de Oliveira, 2017). Perceptual-motor (re)calibration is an ability to scale an action (pace, amplitude, intensity, force, etc.) to available perceptual information following external and internal perturbations (Withagen & Michaels, 2004). For example, walking in dynamic and unpredictable environments, which requires negotiating static obstacles and barriers, involves continuous movement adaptations in path direction, speed, and stride length. These adaptive behaviors emerge from a direct link between perception and action (Gibson, 1979), and their dissociation during task performance can hinder functional coordination in activities of daily living (ADLs). Previous studies have shown that visual perception constrains walking because it provides essential information for upright stability and postural regulation, as well as for body positioning relative to objects (Logan et al., 2010; Menuchi & Gobbi, 2012; Paquette & Vallis, 2010). Paquette and Vallis (2010) showed that, for instance, older adults display a cautious strategy during obstacle crossing due to spending more time looking at the obstacle to pick up relevant perceptual information to guide the actions.

The ecological dynamic approach and the environmental assessment and modification are two approaches that differ in practice. For example, environmental assessment and modification led by an occupational therapist includes the option of introducing a mobility aid or additional assistance with any ADLs. In some cases, environmental elements such as trip hazards are eliminated, and medicine optimization may be advised such as the reduction in psychoactive medications. It has been shown that accident-/environment-related factors such as objects on floors; external forces; and wet, uneven, and icy surfaces are key risk factors for falls in older adults (Talbot, Musiol, Witham, & Metter, 2005).

In contrast, the ecological dynamic approach views the environment as a rich and dynamic contextual backdrop for the older adult, which provides valuable information for action planning and movement adaptations. This study advocates the ecological dynamic approach in the design of exercise interventions for falls prevention because there are opportunities for maintaining mobility and reducing falls risk based on “perception of affordances” (information extracted from surrounding objects and space). There are several reasons for taking this approach. First, natural indoor or outdoor environments in everyday life situations include events and objects that require the integration of the individual’s cognitive and perceptual skills along with appropriate physical actions to mobilize safely in these environments. By creating enriched physical activity environments with different levels of social and cognitive interactions (from home to public places), people can gradually adapt to the level of challenges by exploring their dynamic environments. Second, the likelihood of losing balance in older adults during walking is higher than when standing (Aranda-Gallardo et al., 2018), which indicates a higher degree of complexity in dynamic postural control during walking and a greater need to create an environment to enable a person to practice challenging skills such as walking. Third, the need for perceptual (picking up information to regulate action) and cognitive skills (e.g., navigation, object recognition and negotiation, anticipation, reaction responses, and postural control) to support mobility in everyday life are paramount (Rosenbaum, 2010). This integration of perception, cognition, and action could emerge through creating an enriched environment where participation in everyday physical activities and independent problem solving is encouraged without a significant intervention by practitioners to facilitate the transfer of learning and self-regulatory mechanisms. Finally, the association between fear of fall, low self-efficacy, and the higher perceived risk of environments (Chippendale & Boltz, 2015) that could support the authors’ view that the more exposure to challenging and enriched environments is beneficial for dynamic balance and fall prevention.

An enriched environment is defined as “an intervention to facilitate physical, cognitive and social activity by the provision of equipment and organisation of structured, stimulating environment” (Nithianantharajah & Hannan, 2006). The authors conceptualized an enriched environment to be assessed in an exercise context (a) with familiar environmental and task constraints, (b) with less explicit information provided by a support practitioner and more opportunities for guided discovery and exploration, (c) is representative of everyday life situations, and (d) requiring integrated physical movements and perceptual-cognitive activity. In other words, a physical activity environment that encourages participants to stand from sitting, walk, maneuver their bodies through gaps, up and down steps, turn, reach, and bend, similar to daily living activities, also provides opportunities to use anticipation, pace changes, path direction changes, and encomposes an enriched environment that can improve dynamic stability skills.

Whether exposure to a dynamic and an enriched environment could facilitate postural adaptations in older adults is unknown, and the aim of this scoping review was to identify previous studies that have examined effects on movement behaviors of environmental designs to promote physical activity generally and to enhance dynamic postural balance and falls prevention in older adults.

Methods

The design of this study was to undertake a scoping review (Rumrill, Fitzgerald, & Merchant, 2010) to enable the mapping of the current literature and to identify the size of the topic, as well as to identify gaps in the literature (Arksey & O’Malley, 2005).

The review followed the methodological frameworks of previous scoping reviews (Arksey & O’Malley, 2005; Levac, Colquhoun, & O’Brien, 2010). The framework involved the following five steps: (a) defining a research question, (b) comprehensive and systematic identification of relevant studies, (c) independent and objective screening and selection of studies, (d) extraction and charting of the data, and (e) summary of the findings for recommendations for future research.

Scope of Review/Research Question

The scope of review and the research question were defined using population, intervention, comparison, and outcome format. The operational definitions, outcomes of interest, and the key search strategy were decided and finalized through a consensus in the panel that was formed from experts in rehabilitation/physiotherapy, physical activity/exercise, and movement science. The research question was: Are there enough studies on the effectiveness of various environments on postural stability in older adults? Specifically, an enriched environment was defined as any exercise setting that stimulates the physical, sensory perceptual, and cognitive skills of an individual through the provision of equipment and facilities (Nithianantharajah & Hannan, 2006) to facilitate the transfer of motor learning to everyday life contexts (Araújo, Davids, & Passos, 2007). Postural stability was defined as the ability to maintain balance and postural sway during performance of everyday tasks (Mesbah, Perry, Hill, Kaur, & Hale, 2017).

Literature Search Strategy

The following electronic databases were searched between 1990 and July 2019: MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, ERIC, SportDiscus, Cochran Library, and AMED. The key terms that were used in a combination with “Older adults” were “enriched environment,” “environmental enrichment,” “environmental assessment and modification,” “meaningful activity/task,” “task-oriented activity,” “recreational activity,” “functional tasks,” “stimulating environment,” “enriched rehabilitation,” “task constraints,” “environment constraints,” and “built environment.” Those key terms were always used with specific terms like “Older adults” in separate searches: “environmental enrichment” AND “older adults,” “stimulating environment” AND “older adults,” and so on. In addition, relevant studies in the systematic review and meta-analysis studies were also included after reading the full text of the published article. Key terms were adapted from studies that aimed to increase participation in physical activity and rehabilitation exercises through changing the environment (McDonald, Hayward, Rosbergen, Jeffers, & Corbett, 2018).

Study Selection

Studies were included if they met the following criteria: (a) included participants with a mean age of 65 years and older; (b) the type of study was correlational, cross-sectional, or experimental; (c) the article was published in a peer-reviewed journal; (d) published in English, (e) the dependent variable was neuromotor fitness (e.g., strength, balance, etc.) or quality of life (QoL); (f) the population included able-bodied individuals or people with a long-term condition; and (g) human participants. The studies were excluded if (a) the type of study was descriptive; (b) it was a review study (literature review, systematic review, and meta-analysis); and (c) it was documented in conference proceedings or a dissertation/thesis. Two reviewers (M. Shafizadeh and S. Parvinpour) independently applied the inclusion criteria to select the relevant articles and resolved all disagreements by consensus. The selection process was carried out at title, abstract, and full-text levels. First, the reviewers read the selected titles and identified the relevant studies, and then they read the abstract and full text of selected studies to finalize the list. The final selection was conducted by both reviewers.

Data Extraction and Charting of Data

Two independent reviewers participated in the charting of the data that were extracted from the full text of selected studies. The information that was extracted by the first reviewer (M. Shafizadeh) was verified by the second reviewer (J. Manson). All discrepancies were discussed between the reviewers until a consensus was reached. Unlike most systematic reviews, scoping reviews do not reject studies based on a risk of bias assessment (Arksey & O’Malley, 2005); therefore, the authors did not carry out any quality assessment on the selected studies. The important information that was extracted from the studies was organized by study domain, the participants’ demographic measures, the type of study, the nature of the intervention, and the outcome measures as presented in Table 1.

Table 1

The Main Characteristics of Participants, Intervention, Research Design, and Findings

No.StudyTopicParticipantsType of studyInterventionMeasuresFindings
1Alves et al. (2006)Built environments15 Hispanic and 15 White older adults in the United StatesCross-sectionalN/AViews on the photographs from different environments (natural and authentic)The perspectives of older adults to different environments for participating in physical activity depends on the ethnicity.
2Campbell et al. (2005)Environment modifications391 older adults in New Zealand divided into three groups: assessment and modification, exercise, and bothRandomized controlled trialsThe assessment and modification of hazards at home, exercise program for strength and balance, social visitsFall incident rate in 12 monthsFewer falls were reported in the assessment and modification group not other groups.
3Cerin et al. (2013)Built environments96 older adults in Hong KongCorrelationalN/AAccelerometry and physical environment auditWalking for recreation was positively associated with access to services, street connectivity, indoor places for walking, and bridge/overpass connecting to services.
4Clarke and Gallagher (2013)Built environments1,188 older adults in the United StatesCross-sectionalN/APerception to environment in different activity groupsIndividuals living in more accessible environments had an 18% higher odds of being more active.
5Colom et al. (2019)Built environments218 middle-aged and older adults in SpainCorrelationalN/AAccelerometry and physical environment auditAccessed to walk-friendly routes had an influence on accelerometer-measured physical activity in older adults.
6Cumming et al. (1999)Environment modifications530 older adults in Australia divided into two groups: assessment and modification and controlRandomized controlled trialsThe intervention was a 12-month assessment and modifications of home environmentFall incident rate in 12 monthsThe intervention was effective to reduce the risk of fall in people who reported the fall in the last year.
7Day et al. (2002)Environment modifications1,090 older adults from Australia divided into three groups: assessment and modification, exercise, and vision interventionRandomized controlled trials15-week intervention that emphasized hazard and risk assessments at home, involved an exercise program for balance and strength gains, or were referred to eye care clinicFall incidents, balance, and strengthThe environment hazard assessment was not effective for improving balance, strength, and fall incident reductions, whereas the exercise group improved strength and balance but not fall rate.
8De Vriendt et al. (2019)Environment modifications36 older adults from home cares in BelgiumQuasi-experimentalA client-centered meaningful activity to daily living for 2 yearsPre–post tests on QoL, MMSE, and EMSThe residents experienced a higher satisfaction with their social environment and participation, and they were significantly more satisfied with the offered leisure. QoL remained unchanged, as well as self-perceived performance.
9Engel et al. (2016)Built environments160 community-dwelling older adults in CanadaCross-sectionalN/APerceived built environment measure, QoL, and well-beingOlder adults’ capability well-being was associated with street connectivity and social cohesion, while no statistically significant associations were found between environmental factors and HRQoL.
10Forte et al. (2019)Environment modifications135 older adults in ItalyCross-sectionalDual task under environmental constraints (flat vs. obstructed walking)Gait performance and physical activity levelEnvironmental constraints affected the gait variability and executive function performance. A small contribution of PA in gait variability was reported.
11Gell et al. (2015)Built environments28 middle-aged and older adults with mobility disabilities in the United StatesCorrelationalN/AGPS walking trip, environment walkability scoreMore walkable environments promote active mobility among midlife and older adults with mobility disabilities.
12Hanibuchi et al. (2011)Built environments9,414 older adults in JapanCorrelationalN/AFrequency of leisure-time activity and total walking timePresence of parks or green spaces had positive associations with the active leisure but not walking time.
13Huang et al. (2018)Built environments2,214 older adults in TaiwanCorrelationalN/APhysical activity level and access to the parks and sport centersParks and green spaces were associated with achieving the recommended level of physical activity.
14Janssen et al. (2014)Enriched environment29 older adults with stroke in AustraliaQuasi-experimentalOne group exposed to the enriched environment and another group in nonenriched environment for 10 daysQuantity and type of physical activity through behavioral mapping methodEnriched environment increased the amount of physical activity by 1.2 times, the amount of cognitive activity by 1.7 times, and the amount of social activity by 0.7 times.
15Kolbe-Alexander et al. (2015)Built environments44 older adults in South AfricaCorrelationalN/ASelf-report physical activity, accelerometer, and subjective assessment of neighborhood walkabilityThe perceived built environment was associated with the amount of physical activity and leisure-time activity.
16Lannin et al. (2007)Environment modifications10 older adults in Australia divided into precharge hazard assessment and controlRandomized controlled trialsIntervention was assessment of the functions and environment and education for 12 weeksFall rate, ADLs, and QoLNo changes were reported for any outcome.
17Law et al. (2013)Task constraints11 older adults at risk of Alzheimer’s disease in Hong KongSingle-group repeated measure study10-week (three session per week; 1 hr per session) home-based functional task exercise that includes serial skills, bimanual coordination tasks, switching and memory tasks, body-orientation tasks, and dual taskingADL and cognitive functioning tasksThe intervention significantly improved the cognitive functions and ADLs.
18Law et al. (2018)Task constraints43 older adults with mild cognitive impairment in Hong KongSingle-group repeated measure study13 sessions (10 weeks) participation in functional task exercise same as Law et al. (2013)Chair stand balance test, ADLs, and cognitive function assessmentsThe intervention significantly improved the cognitive functions, balance, and ADLs.
19Leach et al. (2019)Task constraints30 community-dwelling older adults in the United StatesRandomized-control studyThe experimental group participated in attention and stepping accuracy task, whereas the control group took part in bike and strength program for 6 weeksWalking measures, balance, leg strength, and aerobic enduranceStepping group outperformed bike and strength group in balance and maximal step length. The bike and strength group was better in leg strength.
20Li et al. (2005)Built environments577 older adults in the United StatesCross-sectionalN/ASelf-report walking activity and perceived neighborhood environmentAccess to green and open spaces for recreation was associated with walking activity.
21Lin et al. (2007)Environment modifications150 older adults with fall experience in TaiwanSingle-group randomized control trialThe intervention lasted for 4 months and participants received either (a) education, (b) hazard assessment and environment modifications, or (c) exerciseBalance, gait, ADLs, QoL, and fear of fallEducation group improved the QoL score, home safety and environment modification group improved the QoL and functional assessments, and exercise group improved functional assessments.
22Liu et al. (2016)Task constraints14 older adults in the United StatesSingle-group repeated measure study (feasibility study)10 weeks (three to four sessions per week) of three-step workout for life (strength training, functional training, and ADL training)30-s chair stand test, ADLs, and function and disability assessmentSignificant improvements in balance score, disability score, and ADLs activity score.
23Lu et al. (2016)Environment modifications40 older adults with mild cognitive impairment in the United StatesRandomized pre–post intervention designOne group took part in DEMA intervention and another group in information support and attention intervention. The length of study was 3 monthsFunctional ability assessment, self-efficacy, meaningful activity score, and life satisfaction scoreThe DEMA group showed higher scores on functional ability awareness, life satisfaction, and more meaningful activities such as increased the amount of recreational activity and socialization.
24Lu et al. (2018)Built environments720 older adults in Hong KongCorrelationalN/APerceived environment and International Physical Activity QuestionnaireRecreational moderate to vigorous physical activity positively was associated with the number of recreational facilities.
25Mazzei et al. (2014)Built environmentsSix older adults in acute care dementia unit in CanadaCross-sectionalPretest in a traditional geriatric psychiatry unit; posttest in purpose-built acute care (person-centered modifications)Behavior mapping during daytime for 6 monthsThe pattern of activity was changed in the posttest observations and more time spent in the nursing station than in the private rooms. The number of pacing events were decreased.
26Nagel et al. (2008)Built environments546 older adults in the United StatesCorrelationalN/APerceived environment and Yale Physical Activity ScaleNo association between built environment and the likelihood of walking or not walking was observed in this cohort of older adults, but among those who do walk, it was associated with increased levels of activity.
27Nikolaus and Bach (2003)Environment modifications360 older adults with risk of fall in GermanyRandomized pre–post intervention designHome hazard assessment and environment modifications vs. usual care at homeFall rateThe intervention group had 31% fewer fall rate than the control group.
28Nicholson et al. (2014)Task constraints28 older adults in AustraliaRandomized pre–post intervention design15 participants took part in BodyBalance intervention for 12 weeks that was combinations of yoga, tai chi, and Pilates, the control had normal activityTimed up and go, 30-s chair stand, stability score (COP), fear of fall, and QoLSignificant improvements in balance scores but not fear of fall and QoL in the intervention group.
29Pardessus et al. (2002)Environment modifications60 older adults with fall in FranceRandomized controlled studyHome visit for hazard assessment and environment modificationsFall rate, autonomy, and hospitalization due to fallThe intervention group was not different from the control group on the fall rate, hospitalization, and autonomy.
30Parra et al. (2010)Built environments1,966 older adults in BogotaCross-sectionalN/APerceived environment and active park useResidents from areas with higher park density and highland-use mix were more likely to report active park use while those from areas with high connectivity were less likely.
31Pedroso et al. (2018)Task constraints57 older adults with Alzheimer’s disease were divided into three groups including fuctional-task, social, and control groups in BrazilRandomized pre–post intervention designFunctional-task group took part in a 12-week intervention that was combinations of aerobic endurance, flexibility, muscular strength, and balance. The social group took part in group dynamic activities such as singing, dancing, painting, and playing games. The control group just carried on their usual activitiesCognitive function, functional fitness (strength, sit and reach, and 6-min walk test), and balance testFunctional task training had no significant effect on cognitive functions, ADL, and functional fitness.
32Pighills et al. (2011)Environment modifications238 older adults with fall experience in England divided into intervention and control groupsRandomized controlled trialsThe intervention was 12-month assessment and modifications of home environmentFear of fall, QoL, and ADLsThe intervention had no effect on the fear of fall, QoL, and ADLs, but the fall rate was reduced in the intervention group.
33Rosbergen et al. (2017)Enriched environment90 stroke patients in acute unit in Australia were divided into three groups: usual care, enriched environment, and sustainabilityControlled pre–post pilot studyUsual care participants received usual one-on-one allied health intervention and nursing care. The enriched environment participants were provided stimulating resources, communal areas for eating and socializing, and daily group activitiesPhysical activity by behavioral mapping method, mobility index, QoL, and ADLsThe enriched environment group engaged more in daily activity in any domain compared with the usual care. No difference between groups on the ADLs, QoL, and mobility.
34Rosbergen et al. (2019)Enriched environment60 stroke patients in acute unit in Australia were divided into three groups: two usual care groups and one enriched environment groupControlled pre–post pilot studyUsual care participants received usual one-on-one allied health intervention and nursing care. The enriched environment participants were provided stimulating resources, communal areas for eating and socializing, and daily group activitiesPhysical activity by behavioral mapping methodThe enriched environment group spent more time on upper limb activities, iPad activities, communal socialization, and less time spent on lying and sitting, and more time on standing.
35Sato et al. (2019)Built environments3,133 older adults in the United StatesCorrelationalN/APerceived environment and self-report International Physical Activity QuestionnaireAccess to parks and recreational facilities correlates with increased physical activity levels among older adults.
36Soma et al. (2017)Built environments509 older adults in JapanCross-sectionalN/APhysical functions (grip strength, sit to stand, Timed Up and Go, and walking speed), population density, and recreational facilitiesLow population density, land use mix, and recreational facilities were negative determinants of physical functions.
37Stevens et al. (2001)Environment modifications1,879 older adults with fall in AustraliaRandomized controlled trialsThe intervention was 12-month assessment and modifications of home environmentFall rate and incident rate of hazardsNo difference between groups on fall rate and proportion of fall due to hazards.
38Timmermans et al. (2016)Built environments247 older adults with and without lower limb osteoarthritis in HollandCorrelationalN/AAccelerometry and perceived environmentNo measures of the neighborhood built environment were significantly associated with total physical activity.
39Giehl et al. (2016)Built environments1,705 older adults in BrazilCorrelationalN/APerceived environment and International Physical Activity QuestionnaireStreet density was the only predictor of leisure walking activity.
40Winters et al. (2015)Built environments1,309 older adults in CanadaCorrelationalN/ASelf-report outdoor walking and perceived environmentOlder adults living in neighborhoods categorized as Walker’s paradise were over three times more active than those living in car-dependent/very car-dependent neighborhoods.

Note. ADL = activities of daily living; DEMA = daily engagement of meaningful activities; COP = centre of pressure; EMS = elderly mobility scale; QoL = quality of life. N/A = not applicable; HRQoL = health-related quality of life; MMSE = Mini-Mental State Examination; PA = physical activity; TUG = Timed Up and Go.

Results

Of the 197 articles initially identified, 40 studies met the inclusion criteria. The flowchart detailing the selection process is presented in Figure 1. Descriptive data including topics, participants, research design, nature of the intervention, outcome measures, and main findings are presented in Table 1. Most of the studies were published between 2011 and 2019 (28 studies, 70%). Some of the studies were published between 2001 and 2010 (11 studies, 27%), and only one study was published between 1990 and 2000 (3%) that indicates that the topic is still a contemporary issue for studies in the older adult population. The origin of the study was North America (12 studies), Australia (nine studies), Southeast Asia (eight studies), Europe (seven studies), South America (two studies), and Africa (two studies).

Figure 1
Figure 1

—Flow diagram of selection of studies focusing on environments, physical activity, and balance.

Citation: Journal of Aging and Physical Activity 29, 1; 10.1123/japa.2019-0395

Areas of Study

The subject of the published studies was classified into four main areas: (a) built environment and physical activity (19 studies, 48%); (b) environmental modifications, neuromotor fitness, and QoL (12 studies, 30%); (c) task constraints, neuromotor fitness, and QoL (six studies, 15%); and (d) enriched environment in clinical settings (three studies, 7%).

Research Design

Most of studies were randomized controlled trials (20 studies, 50%) that investigated the effect of environment hazards in falls prevention or a specific task intervention on neuromotor fitness components. The correlational study (12 studies, 30%) was the second highest common research design that was mainly used to explore the association between the built environment and physical activity. The other type of research was cross-sectional (eight studies, 20%).

Participants

The participants of this scoping review were only selected from the older adult group (mean age ≥65 years). Due to the nature of the research design, the highest sample size was reported in studies in the built environment (n = 24,096) and then environmental modifications (n = 4,919). The studies in task interventions (n = 183) and enriched environment (n = 179) had the lowest number of participants.

Nature of Intervention

In the selected studies, 22 studies (55%) used a specific intervention, whereas 18 studies (45%) did not implement any interventions. Depending on the nature of the intervention, the study duration was different and ranged from 10 days to 2 years. The task intervention included functional training, dual tasking, strength training, coordination, and balance exercises, and the study duration was between 6 and 12 weeks. The hazard assessment and environment modifications had the longest follow-up period (1–2 years) and mainly included home visits to reduce the number of potential hazards and one-on-one education. The special care units were the main context for enriched environments that was facilitated by the staff to provide more tasks and activities for physical, cognitive, and social involvements.

Main Findings

The outcome measures that were reported in the selected studies included a combination of physical activity level (Colom et al., 2019; Forte et al., 2019; Gell, Rosenberg, Carlson, Kerr, & Belza, 2015; Giehl, Hallal, Corseuil, Schneider, & d’Orsi, 2016; Hanibuchi, Kawachi, Nakaya, Hirai, & Kondo, 2011; Huang, Kung, & Hu, 2018; Janssen et al., 2014; Kolbe-Alexander, Pacheco, Tomaz, Karpul, & Lambert, 2015; Li, Fisher, Brownson, & Bosworth, 2005; Lu, Chen, Yang, & Gou, 2018; Mazzei, Gillan, & Cloutier, 2014; Nagel, Carlson, Bosworth, & Michael, 2008; Parra, Gomez, Fleischer, & Pinzon, 2010; Rosbergen et al., 2017; Rosbergen, Grimley, Hayward, & Brauer, 2019; Sato, Inoue, Du, & Funk, 2019; Timmermans et al., 2016; Winters et al., 2015), falling rates (Campbell et al., 2005; Cumming et al., 1999; Day et al., 2002; Lannin et al., 2007; Nikolaus & Bach, 2003; Pardessus et al., 2002; Stevens, Holman, Bennett, & De Klerk, 2001), QoL (De Vriendt, Cornelis, Vanbosseghem, Desmet, & Van de Velde, 2019; Engel et al., 2016; Lannin et al., 2007; Lin, Wolf, Hwang, Gong, & Chen, 2007; Nicholson, McKean, & Burkett, 2014; Pighills, Torgerson, Sheldon, Drummond, & Bland, 2011; Rosbergen et al., 2017), ADL (Lannin et al., 2007; Law, Barnett, Yau, & Gray, 2013; Law, Fong, & Yau, 2018; Liu, Jones, Formyduval, & Clark, 2016; Pighills et al., 2011; Rosbergen et al., 2017), neuromotor fitness (Leach, Maring, & Costello, 2019; Lin et al., 2007; Lu et al., 2016; Nicholson et al., 2014; Pedroso et al., 2018; Soma et al., 2017), and cognitive functioning (Janssen et al., 2014; Law et al., 2013, 2018; Pedroso et al., 2018).

In the studies that aimed to find a relationship between built environments and physical activity, there was a positive association between the level of physical activity and access to green parks and recreational facilities; however, the link to well-being and QoL was not conclusive. The environmental modifications reported a mixed effect on fall rate and QoL. In other words, three studies (42%) have shown a positive effect of environment modifications on fall rate (Campbell et al., 2005; Cumming et al., 1999; Nikolaus & Bach, 2003). Of the seven studies that measured QoL, six studies did not report any changes (De Vriendt et al., 2019; Engel et al., 2016; Lannin et al., 2007; Nicholson et al., 2014; Pighills et al., 2011; Rosbergen et al., 2017). The task constraint interventions resulted in significant improvements in neuromotor fitness components such as balance, strength, and ADLs, but their effects on cognitive functions and fear of falling were inconsistent. The studies that examined the effects of enriched environments on physical, cognitive, and social functions showed that the effects of increased levels of physical activity led to an increase in the amount of socialization time in stroke survivors. Other domains (e.g., QoL and ADLs) were not affected significantly.

Discussion

The aim of this scoping review was to identify previous studies that have examined the effects of environments on the level of physical activity generally, and dynamic postural balance and fall prevention specifically, in older adults. The findings of the current analysis showed that there were 19 studies that reported a positive relationship between built environments and the level of physical activity in older adults. In addition, there were 12 studies that related to the positive effects of environmental modifications on falls prevention and the effectiveness of task constraints on neuromotor improvements in this population group. An enriched environment tended to be specifically used only for stroke survivors in acute units and included any task that could facilitate the physical activity, cognitive functioning, and socialization of participants (Janssen et al., 2014; Rosbergen et al., 2017, , 2019). Altogether, these findings suggest that an enriched environment can facilitate the activity of participants and that manipulating the task constraints in the targeted context can enhance neuromotor fitness in older adults.

A central question concerns how physical environments change mobility and the risks of falling. There were different views expressed on the implications of the findings for fall prevention that are reviewed in this study: environment assessment and modification approach and ecological dynamic approach. However, both approaches emphasize the interactions between a person and environments; therefore, their differences have to do with the applications. For example, in the environmental assessment and modification approach that tends to be used by occupational therapists, the environmental elements are viewed as hazards that increase the risk of falling, whereas in the ecological dynamic approach, the perception of environments (affordances) plays an important role in anticipation, judgment, and spatiotemporal awareness that are important for fall prevention in more dynamic and challenging environments (Fajen & Matthis, 2011). In fact, in a truly preventative approach, the combination of challenges presented by an enriched environment could engage patients to in more representative everyday life situations where the environment is used as a way to provide older adults with an opportunity for risk management and fall prevention. The focus on indoor falls prevention in the health care centers has so far concentrated on mitigating risks in the home environment, but this approach also allows the older adult to consider the navigation and use of outdoor spaces as a potential place to exercise and maintain mobility and function.

As a method for rehabilitation in acute stroke units, the enriched environment also emphasizes on stimulating experiences to enhance exploration and engagement in social, cognitive, and sensorimotor activities to promote recovery (Rosbergen et al., 2019). This type of environment might be appropriate to increase physical activity and upper limbs functioning after brain injuries, but its applications in older adults without any neurological disabilities might require different task/environmental designs that have yet to be studied. Furthermore, the other interventions that mainly aimed to improve neuromotor fitness components of participants through manipulating task constraints (Leach et al., 2019; Liu et al., 2016; Nicholson et al., 2014) currently lack credibility because the interventions do not emphasize guided discovery and exploration, were less representative of the everyday life situations, and lacked integration between physical movements and perceptual-cognitive activity. Only a few studies (Law et al., 2013, 2018; Pedroso et al., 2018) have used some kind of functional training procedures to enhance cognitive functions, ADLs, and balance. However, they either displayed contradictory findings or only recruited participants with cognitive impairments that might limit the generalization of the outcomes to other groups of older adults (e.g., those with greater risks of falling and those who were generally fit and healthy).

By identifying the previously mentioned limitations in the previous studies, there are two versions of an enriched environment for enhancing dynamic postural stability that are recommended for future study interventions. The proposed interventions could borrow principles from the ecological dynamic approach (Fajen & Matthis, 2011) that mainly emphasize functionality of perception, cognitions and actions, and the representative design of tasks.

Environmental Constrained Physical Activity

Dynamic postural stability during locomotion significantly relies on the strategy, cognitive planning, and perception of surrounding environments (Rosenbaum, 2010). According to the theory of direct perception (Gibson, 1979), an organism could directly utilize environmental information for action planning without added explicit instructions from a therapist. Hence, exercise sessions with aims to improve dynamic postural stability and falls prevention need to stimulate continuous perception–action coupling in training designs (representativeness) to educate the attention of participants (picking up or ignoring information from the surroundings, such as objects, equipment, space, and people). In fact, the environment should be designed to encourage activities, and it should be stimulating to encourage motor learning (Nithianantharajah & Hannan, 2006), and to cause older adults to initiate and maintain movement.

The emergence of body adaptations through constraining the environments and tasks, as a training method, has been used extensively in the investigations of sport performance where the roles of cognitive activity, perception, decision making, and tactical behaviors are paramount (Davids, Araújo, Correia, & Vilar, 2013). In this approach to practice designs in sport, the emphasis is on exposing the participant to a dynamic environment (game-like situations) instead of constant repetition of techniques (e.g., running, passing, tackling, shooting, etc.). Traditionally, practice of these techniques occur in isolation from the targeted performance context, and motor behaviors emerge that are somewhat artificial and dissimilar to perceptual-motor experiences of competitive sports environments. In contrast, ecological dynamics proposes that practice environments should simulate performance environments to improve creativity, problem solving, and self-organization without a need for explicit augmented instructions of coaches and practitioners (Davids et al., 2013). So, older adults at risk of falling can be engaged in a “training” that includes a range of functional tasks that promote the maintenance of active engagement in the environment through movement.

A new form of complex intervention (environmental constrained physical activity [ECPA]) could be used for fall prevention in healthy older adults and fall rehabilitation in people with fall experiences. Instead of designing an exercise setting to repeat the same movement pattern in long period of time (e.g., biking, treadmill walking and running, pulling/pushing the weight machines, etc.) or performing specific exercise routines in closed environments (e.g., yoga, tai chi, Pilates, etc.), a falls prevention program could emphasize the adaptation of movements in dynamic and challenging environments to help individuals (re)calibrate postural adaptations needed for satisfying contextual demands. The ECPA could be designed by integrations of health-related fitness components (muscular strength, muscular endurance, and aerobic capacity); motor fitness components (agility, speed, reaction, coordination, and balance); and perceptual and cognitive functions (decision making, dual tasking, problem solving, and perception of visual and haptic information) to simulate the ADLs. The ECPA model could be investigated as a preventive or rehabilitation strategy for fall incident and postural balance in older adults in future studies.

Senior Playgrounds in Parks

The implications of affordance perception in promoting physical activity also were supported by the tenets of an ecological dynamic approach. From this point of view, practitioners are physical activity designers who create or reshape the designs of urban areas, parks, green spaces, residential complexes, and travel venues based on the relevant affordances to encourage physical activity (Davids, Araújo, & Brymer, 2016). Studies on the relationship between built environments and physical activity in older adults have also suggested that access to parks, open areas, and recreational facilities has a positive association with increased physical activity (Timmermans et al., 2016; Winters et al., 2015). Urban and public places should encourage physical activity and enable older adults to participate in more outdoor exercises (Cinderby et al., 2018). The findings of inclusive design for getting outdoor (Inclusive Design for Getting Outdoors, 2006) project showed that if older adults live in an environment that makes it easy and enjoyable for them to go outdoors, they are more likely to be physically active and satisfied with life. This finding along with other similar studies demonstrated that the quality and accessibility of the urban spaces have a facilitator role in the physical activity and well-being of older adults (Keskinen, Rantakokko, Suomi, Rantanen, & Portegijs, 2018; Levasseur et al., 2015).

However, there is no evidence to show that access to green park areas has positive effects on the regulation of dynamic postural balance and fall prevention. This specific topic requires further study in the future. One idea is to utilize the affordances that are embedded in nature (e.g., slopes, uneven surfaces, trails, muddy tracks, etc.) or to design special activity spaces for older adults, similar to children’s playgrounds, which encourage them to continuously challenge their postural control and balancing skills in a safe environment. Activities in modified forms such as walking on river stepping stones, rope climbing, tire swinging, and ladder walking could provide opportunities to increase balance and postural skills.

This is the first study that reviewed the different roles of environments on physical activity and balance functions in older adults. This review is a unique attempt to recognize the differences between the existing frames of reference used in rehabilitation for fall prevention (home-based environmental risk assessment) and the ecological dynamic approach that promotes a holistic approach to movement and considers the normalization of exercise and activity indoors and outdoors. However, this study has some limitations in its methodology. There are qualitative studies on the role of environments in the aging population that were not included in this scoping review. Also, due to the nature of the authors’ review, the quality of included studies was not assessed and might slightly affect the implications of the authors’ findings.

Conclusion

The results of this scoping review showed that there is insufficient work utilizing the physical activity environment as a vehicle for improving dynamic postural balance and fall prevention in older adults. It is necessary to formulate the research questions on the randomized controlled trials that are related to the physical and cognitive functions and fall prevention in everyday scenarios and in the context of enriched environments. Here, it was proposed that a comprehensive theoretical framework to explain human movement behaviors, such as ecological dynamic approach, might provide a useful underpinning for further research and practical work on effects of enriching physical activity environments.

References

  • Alves, S.M., Gulwadi, G.B., & Cohen, U. (2006). Accommodating culturally meaningful activities in outdoor settings for older adults. Journal of Housing for the Elderly, 19(3–4), 109140. doi:10.1300/J081v19n03_07

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Aranda-Gallardo, M., Morales-Asencio, J.M., de Luna-Rodriguez, M.E., Vazquez-Blanco, M.J., Morilla-Herrera, J.C., Rivas-Ruiz, F., … Canca-Sanchez, J.C. (2018). Characteristics, consequences and prevention of falls in institutionalised older adults in the province of Malaga (Spain): A prospective, cohort, multicentre study. BMJ Open, 8(2), e020039. PubMed ID: 29476031 doi:10.1136/bmjopen-2017-020039

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Araújo, D., Davids, K., & Passos, P. (2007). Ecological validity, representative design, and correspondence between experimental task constraints and behavioral setting: Comment on Rogers, Kadar, and Costall (2005). Ecological Psychology, 19(1), 6978.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8(1), 1932. doi:10.1080/1364557032000119616

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bergen, G., Stevens, M.R., & Burns, E.R. (2016). Falls and fall injuries among adults aged ≥65 years—United States, 2014. MMWR. Morbidity and Mortality Weekly Report, 65(37), 993998. PubMed ID: 27656914 doi:10.15585/mmwr.mm6537a2

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Brand, M.T., & de Oliveira, R.F. (2017). Recalibration in functional perceptual-motor tasks: A systematic review. Human Movement Science, 56(PtB), 5470. PubMed ID: 29102772 doi:10.1016/j.humov.2017.10.020

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Campbell, A.J., Robertson, M.C., La Grow, S.J., Kerse, N.M., Sanderson, G.F., Jacobs, R.J., … Hale, L.A. (2005). Randomised controlled trial of prevention of falls in people aged ≥75 with severe visual impairment: The VIP trial. British Medical Journal, 331(7520), 817. doi:10.1136/bmj.38601.447731.55

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Cerin, E., MacFarlane, D., Sit, C., Ho, S., Johnston, J., Chou, K.L., … Ho, K. (2013). Effects of built environment on walking among Hong Kong older adults. Hong Kong Medical Journal, 19(3), S39S41.

    • Search Google Scholar
    • Export Citation
  • Chang, J.T., Morton, S.C., Rubenstein, L.Z., Mojica, W.A., Maglione, M., Suttorp, M.J., … Shekelle, P.G. (2004). Interventions for the prevention of falls in older adults: Systematic review and meta-analysis of randomised clinical trials. British Medical Journal, 328(7441), 680. doi:10.1136/bmj.328.7441.680

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Chippendale, T., & Boltz, M. (2015). The neighborhood environment: Perceived fall risk, resources, and strategies for fall prevention. Gerontologist, 55(4), 575583. PubMed ID: 24836115 doi:10.1093/geront/gnu019

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Cinderby, S., Cambridge, H., Attuyer, K., Bevan, M., Croucher, K., Gilroy, R., & Swallow, D. (2018). Co-designing urban living solutions to improve older people’s mobility and well-being. Journal of Urban Health, 95(3), 409422 PubMed ID: 29644534 doi:10.1007/s11524-018-0232-z

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Clarke, P., & Gallagher, N.A. (2013). Optimizing mobility in later life: The role of the urban built environment for older adults aging in place. Journal of Urban Health, 90(6), 9971009. PubMed ID: 23592019 doi:10.1007/s11524-013-9800-4

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Clemson, L., Stark, S., Pighills, A.C., Torgerson, D.J., Sherrington, C., & Lamb, S.E. (2019). Environmental interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 2019(2), CD013258.

    • Search Google Scholar
    • Export Citation
  • Colom, A., Ruiz, M., Wärnberg, J., Compa, M., Muncunill, J., Barón-López, F.J., … Fitó, M. (2019). Mediterranean built environment and precipitation as modulator factors on physical activity in obese mid-age and old-age adults with metabolic syndrome: Cross-sectional study. International Journal of Environmental Research and Public Health, 16(5), 854. doi:10.3390/ijerph16050854

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Cumming, R.G., Thomas, M., Szonyi, G., Salkeld, G., O’Neill, E., Westbury, C., & Frampton, G. (1999). Home visits by an occupational therapist for assessment and modification of environmental hazards: A randomized trial of falls prevention. Journal of the American Geriatrics Society, 47(12), 13971402. PubMed ID: 10591231 doi:10.1111/j.1532-5415.1999.tb01556.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Daly, R.M., Rosengren, B.E., Alwis, G., Ahlborg, H.G., Sernbo, I., & Karlsson, M.K. (2013). Gender specific age-related changes in bone density, muscle strength and functional performance in the elderly: A-10 year prospective population-based study. BMC Geriatrics, 13(1), 71. doi:10.1186/1471-2318-13-71

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Davids, K., Araújo, D., & Brymer, E. (2016). Designing affordances for health-enhancing physical activity and exercise in sedentary individuals. Sports Medicine, 46(7), 933938. PubMed ID: 26914265 doi:10.1007/s40279-016-0511-3

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Davids, K., Araújo, D., Correia, V., & Vilar, L. (2013). How small-sided and conditioned games enhance acquisition of movement and decision-making skills. Exercise and Sport Sciences Reviews, 41(3), 154161. PubMed ID: 23558693 doi:10.1097/JES.0b013e318292f3ec

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Day, L., Fildes, B., Gordon, I., Fitzharris, M., Flamer, H., & Lord, S. (2002). Randomised factorial trial of falls prevention among older people living in their own homes. British Medical Journal, 325(7356), 128128. PubMed ID: 12130606 doi:10.1136/bmj.325.7356.128

    • Crossref
    • Search Google Scholar
    • Export Citation
  • De Vriendt, P., Cornelis, E., Vanbosseghem, R., Desmet, V., & Van de Velde, D. (2019). Enabling meaningful activities and quality of life in long-term care facilities: The stepwise development of a participatory client-centred approach in Flanders. British Journal of Occupational Therapy, 82(1), 1526. doi:10.1177/0308022618775880

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Dhital, A., Pey, T., & Stanford, M.R. (2010). Visual loss and falls: A review. Eye, 24(9), 14371446. doi:10.1038/eye.2010.60

  • Engel, L., Chudyk, A., Ashe, M., McKay, H., Whitehurst, D., & Bryan, S. (2016). Older adults’ quality of life-exploring the role of the built environment and social cohesion in community-dwelling seniors on low income. Social Science & Medicine, 164, 111. PubMed ID: 27439120 doi:10.1016/j.socscimed.2016.07.008

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Fajen, B.R., & Matthis, J.S. (2011). Direct perception of action-scaled affordances: The shrinking gap problem. Journal of Experimental Psychology: Human Perception and Performance, 37(5), 14421457. PubMed ID: 21500936

    • Search Google Scholar
    • Export Citation
  • Forte, R., Pesce, C., Di Baldassarre, A., Shea, J., Voelcker-Rehage, C., Capranica, L., & Condello, G. (2019). How older adults cope with cognitive complexity and environmental constraints during dual-task walking: The role of executive function involvement. International Journal of Environmental Research and Public Health, 16(10), 1835. doi:10.3390/ijerph16101835

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gale, C.R., Cooper, C., & Aihie Sayer, A. (2016). Prevalence and risk factors for falls in older men and women: The English longitudinal study of ageing. Age and Ageing, 45(6), 789794. PubMed ID: 27496938 doi:10.1093/ageing/afw129

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gell, N.M., Rosenberg, D.E., Carlson, J., Kerr, J., & Belza, B. (2015). Built environment attributes related to GPS measured active trips in mid-life and older adults with mobility disabilities. Disability and Health Journal, 8(2), 290295. PubMed ID: 25637503 doi:10.1016/j.dhjo.2014.12.002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gibson, J. (1979). The ecological approach to visual perception. Boston, MA: Houghton, Mifflin and Company.

  • Giehl, M.W.C., Hallal, P.C., Corseuil, C.W., Schneider, I.J.C., & d’Orsi, E. (2016). Built environment and walking behavior among Brazilian older adults: A population-based study. Journal of Physical Activity & Health, 13(6), 617624. doi:10.1123/jpah.2015-0355

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gillespie, L., & Handoll, H. (2009). Prevention of falls and fall-related injuries in older people. Injury Prevention, 15(5), 354355. PubMed ID: 19805608 doi:10.1136/ip.2009.023101

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Guirguis-Blake, J.M., Michael, Y.L., Perdue, L.A., Coppola, E.L., & Beil, T.L. (2018). Interventions to prevent falls in older adults: Updated evidence report and systematic review for the US preventive services task force. Journal of the American Medical Association, 319(16), 17051716. PubMed ID: 29710140 doi:10.1001/jama.2017.21962

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hall, E., & Wilton, R. (2017). Towards a relational geography of disability. Progress in Human Geography, 41(6), 727744. doi:10.1177/0309132516659705

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hanibuchi, T., Kawachi, I., Nakaya, T., Hirai, H., & Kondo, K. (2011). Neighborhood built environment and physical activity of Japanese older adults: Results from the Aichi Gerontological Evaluation Study (AGES). BMC Public Health, 11(1), 657. doi:10.1186/1471-2458-11-657

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Huang, N.-C., Kung, S.-F., & Hu, S. (2018). The relationship between urbanization, the built environment, and physical activity among older adults in Taiwan. International Journal of Environmental Research and Public Health, 15(5), 836. doi:10.3390/ijerph15050836

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Inclusive Design for Getting Outdoors. (2006). About inclusive design for getting outdoors. Retrieved from www.idago.ac.uk

  • Janssen, H., Ada, L., Bernhardt, J., McElduff, P., Pollack, M., Nilsson, M., & Spratt, N.J. (2014). An enriched environment increases activity in stroke patients undergoing rehabilitation in a mixed rehabilitation unit: A pilot non-randomized controlled trial. Disability and Rehabilitation, 36(3), 255262. PubMed ID: 23627534 doi:10.3109/09638288.2013.788218

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kabeshova, A., Annweiler, C., Fantino, B., Philip, T., Gromov, V., Launay, C., & Beauchet, O. (2014). A regression tree for identifying combinations of fall risk factors associated to recurrent falling: A cross-sectional elderly population-based study. Aging Clinical and Experimental Research, 26(3), 331336. PubMed ID: 24781832 doi:10.1007/s40520-014-0232-0

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Keskinen, K.E., Rantakokko, M., Suomi, K., Rantanen, T., & Portegijs, E. (2018). Nature as a facilitator for physical activity: Defining relationships between the objective and perceived environment and physical activity among community-dwelling older people. Health & Place, 49, 111119. PubMed ID: 29306140 doi:10.1016/j.healthplace.2017.12.003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kolbe-Alexander, T.L., Pacheco, K., Tomaz, S.A., Karpul, D., & Lambert, E.V. (2015). The relationship between the built environment and habitual levels of physical activity in South African older adults: A pilot study. BMC Public Health, 15(1), 518. doi:10.1186/s12889-015-1853-8

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lannin, N.A., Clemson, L., McCluskey, A., Lin, C.-W.C., Cameron, I.D., & Barras, S. (2007). Feasibility and results of a randomised pilot-study of pre-discharge occupational therapy home visits. BMC Health Services Research, 7(1), 42. doi:10.1186/1472-6963-7-42

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Law, L.L., Barnett, F., Yau, M.K., & Gray, M.A. (2013). Development and initial testing of functional task exercise on older adults with cognitive impairment at risk of Alzheimer’s disease-FcTSim programme-a feasibility study. Occupational Therapy International, 20(4), 185197. PubMed ID: 23761291 doi:10.1002/oti.1355

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Law, L.L., Fong, K.N., & Yau, M.M. (2018). Can functional task exercise improve executive function and contribute to functional balance in older adults with mild cognitive impairment? A pilot study. British Journal of Occupational Therapy, 81(9), 495502. doi:10.1177/0308022618763492

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P., & Letts, L. (1996). The person-environment-occupation model: A transactive approach to occupational performance. Canadian Journal of Occupational Therapy, 63(1), 923. doi:10.1177/000841749606300103

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Leach, S.J., Maring, J.R., & Costello, E. (2019). The effects of a divided-attention timed stepping accuracy task on balance, strength, endurance, and functional performance in healthy older adults: A pilot study. Journal of Aging and Physical Activity, 27(4), 521528. PubMed ID: 30676218 doi:10.1123/japa.2018-0010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Levac, D., Colquhoun, H., & O’Brien, K.K. (2010). Scoping studies: Advancing the methodology. Implementation Science, 5(1), 69. doi:10.1186/1748-5908-5-69

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Levasseur, M., Généreux, M., Bruneau, J., Vanasse, A., Chabot, É., Beaulac, C., & Bédard, M.-M. (2015). Importance of proximity to resources, social support, transportation and neighborhood security for mobility and social participation in older adults: Results from a scoping study. BMC Public Health, 15(1), 503. PubMed ID: 26002342 doi:10.1186/s12889-015-1824-0

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Li, F., Fisher, K.J., Brownson, R.C., & Bosworth, M. (2005). Multilevel modelling of built environment characteristics related to neighbourhood walking activity in older adults. Journal of Epidemiology & Community Health, 59(7), 558564. PubMed ID: 15965138 doi:10.1136/jech.2004.028399

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lin, M.R., Wolf, S.L., Hwang, H.F., Gong, S.Y., & Chen, C.Y. (2007). A randomized, controlled trial of fall prevention programs and quality of life in older fallers. Journal of the American Geriatrics Society, 55(4), 499506. PubMed ID: 17397426 doi:10.1111/j.1532-5415.2007.01146.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Liu, C.-J., Jones, L.Y., Formyduval, A.R., & Clark, D.O. (2016). Task-oriented exercise to reduce activities of daily living disability in vulnerable older adults: A feasibility study of the 3-step workout for life. Journal of Aging & Physical Activity, 24(3), 384392. doi:10.1123/japa.2015-0070

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Logan, D., Kiemel, T., Dominici, N., Cappellini, G., Ivanenko, Y., Lacquaniti, F., & Jeka, J.J. (2010). The many roles of vision during walking. Experimental Brain Research, 206(3), 337350. PubMed ID: 20852990 doi:10.1007/s00221-010-2414-0

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lu, Y., Chen, L., Yang, Y., & Gou, Z. (2018). The association of built environment and physical activity in older adults: Using a citywide public housing scheme to reduce residential self-selection bias. International Journal of Environmental Research and Public Health, 15(9), 1973. doi:10.3390/ijerph15091973

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lu, Y.Y.F., Bakas, T., Yang, Z., Weaver, M.T., Austrom, M.G., & Haase, J.E. (2016). Feasibility and effect sizes of the revised daily engagement of meaningful activities intervention for individuals with mild cognitive impairment and their caregivers. Journal of Gerontological Nursing, 42(3), 4558. PubMed ID: 26934973 doi:10.3928/00989134-20160212-08

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mazzei, F., Gillan, R., & Cloutier, D. (2014). Exploring the influence of environment on the spatial behavior of older adults in a purpose-built acute care dementia unit. American Journal of Alzheimer’s Disease & Other Dementias, 29(4), 311319. PubMed ID: 32417775 doi:10.1177/1533317513517033

    • Crossref
    • Search Google Scholar
    • Export Citation
  • McDonald, M.W., Hayward, K.S., Rosbergen, I.C., Jeffers, M.S., & Corbett, D. (2018). Is environmental enrichment ready for clinical application in human post-stroke rehabilitation? Frontiers in Behavioral Neuroscience, 12, 135. PubMed ID: 30050416 doi:10.3389/fnbeh.2018.00135

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Melzer, I., Kurz, I., & Oddsson, L.I. (2010). A retrospective analysis of balance control parameters in elderly fallers and non-fallers. Clinical Biomechanics, 25(10), 984988. PubMed ID: 20696509 doi:10.1016/j.clinbiomech.2010.07.007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Menuchi, M.R.T.P., & Gobbi, L.T.B. (2012). Optic flow contribution to locomotion adjustments in obstacle avoidance. Motor Control, 16(4), 506520. doi:10.1123/mcj.16.4.506

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mesbah, N., Perry, M., Hill, K.D., Kaur, M., & Hale, L. (2017). Postural stability in older adults with Alzheimer disease. Physical Therapy, 97(3), 290309. PubMed ID: 28204720

    • Search Google Scholar
    • Export Citation
  • Nagel, C.L., Carlson, N.E., Bosworth, M., & Michael, Y.L. (2008). The relation between neighborhood built environment and walking activity among older adults. American Journal of Epidemiology, 168(4), 461468. PubMed ID: 18567638 doi:10.1093/aje/kwn158

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Nicholson, V.P., McKean, M.R., & Burkett, B.J. (2014). Twelve weeks of BodyBalance® training improved balance and functional task performance in middle-aged and older adults. Clinical Interventions in Aging, 9, 1895. PubMed ID: 25395844 doi:10.2147/CIA.S71769

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Nikolaus, T., & Bach, M. (2003). Preventing falls in community-dwelling frail older people using a home intervention team (HIT): Results from the randomized Falls-HIT trial. Journal of the American Geriatrics Society, 51(3), 300305. PubMed ID: 12588572 doi:10.1046/j.1532-5415.2003.51102.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Nithianantharajah, J., & Hannan, A.J. (2006). Enriched environments, experience-dependent plasticity and disorders of the nervous system. Nature Reviews Neuroscience, 7(9), 697709. PubMed ID: 16924259 doi:10.1038/nrn1970

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Nyberg, L., & Gustafson, Y. (1995). Patient falls in stroke rehabilitation: A challenge to rehabilitation strategies. Stroke, 26(5), 838842. PubMed ID: 7740577 doi:10.1161/01.STR.26.5.838

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Paquette, M.R., & Vallis, L.A. (2010). Age-related kinematic changes in late visual-cueing during obstacle circumvention. Experimental Brain Research, 203(3), 563574. PubMed ID: 20467732 doi:10.1007/s00221-010-2263-x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Pardessus, V., Puisieux, F., Di Pompeo, C., Gaudefroy, C., Thevenon, A., & Dewailly, P. (2002). Benefits of home visits for falls and autonomy in the elderly: A randomized trial study. American Journal of Physical Medicine & Rehabilitation, 81(4), 247252. PubMed ID: 11953541 doi:10.1097/00002060-200204000-00002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Parra, D.C., Gomez, L.F., Fleischer, N.L., & Pinzon, J.D. (2010). Built environment characteristics and perceived active park use among older adults: Results from a multilevel study in Bogota. Health & Place, 16(6), 11741181. PubMed ID: 20708426 doi:10.1016/j.healthplace.2010.07.008

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Pedroso, R.V., Ayán, C., Fraga, F.J., da Silva, T.M., Cancela, J.M., & Santos-Galduròz, R.F. (2018). Effects of functional-task training on older adults with Alzheimer’s disease. Journal of Aging and Physical Activity, 26(1), 97105. PubMed ID: 28513303 doi:10.1123/japa.2016-0147

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Perell, K.L., Nelson, A., Goldman, R.L., Luther, S.L., Prieto-Lewis, N., & Rubenstein, L.Z. (2001). Fall risk assessment measures: An analytic review. The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 56(12), M761M766. doi:10.1093/gerona/56.12.M761

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Pighills, A., Drummond, A., Crossland, S., & Torgerson, D.J. (2019). What type of environmental assessment and modification prevents falls in community dwelling older people? British Medical Journal, 364, l880. PubMed ID: 30872322 doi:10.1136/bmj.l880

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Pighills, A.C., Torgerson, D.J., Sheldon, T.A., Drummond, A.E., & Bland, J.M. (2011). Environmental assessment and modification to prevent falls in older people. Journal of the American Geriatrics Society, 59(1), 2633. PubMed ID: 21226674 doi:10.1111/j.1532-5415.2010.03221.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Public Health England. (2017). Falls and fracture consensus statement: Supporting commissioning for prevention. National falls prevention coordination group report. London, UK: PHE Publications Gateway.

    • Search Google Scholar
    • Export Citation
  • Qiu, F., Cole, M.H., Davids, K., Hennig, E., Silburn, P., Netscher, H., & Kerr, G. (2012). Enhanced somatosensory information decreases postural sway in older people. Gait & Posture, 35(4), 630635. PubMed ID: 22245163 doi:10.1016/j.gaitpost.2011.12.013

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rensink, M., Schuurmans, M., Lindeman, E., & Hafsteinsdóttir, T. (2009). Falls: Incidence and risk factors after stroke. A systematic literature review. Tijdschrift Voor Gerontologie en Geriatrie, 40(4), 156167. PubMed ID: 20088342 doi:10.1007/BF03079581

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rosbergen, I.C., Grimley, R.S., Hayward, K.S., & Brauer, S.G. (2019). The impact of environmental enrichment in an acute stroke unit on how and when patients undertake activities. Clinical Rehabilitation, 33(4), 784795. PubMed ID: 30582368 doi:10.1177/0269215518820087

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rosbergen, I.C., Grimley, R.S., Hayward, K.S., Walker, K.C., Rowley, D., Campbell, A.M., … Janssen, H. (2017). Embedding an enriched environment in an acute stroke unit increases activity in people with stroke: A controlled before-after pilot study. Clinical Rehabilitation, 31(11), 15161528. PubMed ID: 28459184 doi:10.1177/0269215517705181

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rosenbaum, D.A. (2010). Human motor control. London, UK: Elsevier.

  • Rumrill, P.D., Fitzgerald, S.M., & Merchant, W.R. (2010). Using scoping literature reviews as a means of understanding and interpreting existing literature. Work, 35(3), 399404.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Sánchez, C.C., Murillo, D.B., Davids, K., & Hernández, F.J.M. (2016). Variations in task constraints shape emergent performance outcomes and complexity levels in balancing. Experimental Brain Research, 234(6), 16111622. PubMed ID: 26838357 doi:10.1007/s00221-016-4563-2

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Sato, M., Inoue, Y., Du, J., & Funk, D.C. (2019). Access to parks and recreational facilities, physical activity, and health care costs for older adults: Evidence from US counties. Journal of Leisure Research, 50(3), 220238. doi:10.1080/00222216.2019.1583048

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Scuffham, P., Chaplin, S., & Legood, R. (2003). Incidence and costs of unintentional falls in older people in the United Kingdom. Journal of Epidemiology & Community Health, 57(9), 740744. PubMed ID: 12933783 doi:10.1136/jech.57.9.740

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Soma, Y., Tsunoda, K., Kitano, N., Jindo, T., Tsuji, T., Saghazadeh, M., & Okura, T. (2017). Relationship between built environment attributes and physical function in Japanese community-dwelling older adults. Geriatrics & Gerontology International, 17(3), 382390. PubMed ID: 26800502 doi:10.1111/ggi.12717

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Stephens, L., Ruddick, S., & McKeever, P. (2015). Disability and Deleuze: An exploration of becoming and embodiment in children’s everyday environments. Body & Society, 21(2), 194220. doi:10.1177/1357034X14541155

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Stevens, M., Holman, C.D.A.J., Bennett, N., & De Klerk, N. (2001). Preventing falls in older people: Outcome evaluation of a randomized controlled trial. Journal of the American Geriatrics Society, 49(11), 14481455. PubMed ID: 11890582 doi:10.1046/j.1532-5415.2001.4911236.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Talbot, L.A., Musiol, R.J., Witham, E.K., & Metter, E.J. (2005). Falls in young, middle-aged and older community dwelling adults: Perceived cause, environmental factors and injury. BMC Public Health, 5(1), 86. doi:10.1186/1471-2458-5-86

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Timmermans, E.J., Schaap, L.A., Visser, M., van der Ploeg, H.P., Wagtendonk, A.J., van der Pas, S., & Deeg, D.J. (2016). The association of the neighbourhood built environment with objectively measured physical activity in older adults with and without lower limb osteoarthritis. BMC Public Health, 16(1), 710. doi:10.1186/s12889-016-3347-8

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Winters, M., Barnes, R., Venners, S., Ste-Marie, N., McKay, H., Sims-Gould, J., & Ashe, M. (2015). Older adults’ outdoor walking and the built environment: Does income matter? BMC Public Health, 15(1), 876. doi:10.1186/s12889-015-2224-1

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Withagen, R., & Michaels, C.F. (2004). Transfer of calibration in length perception by dynamic touch. Perception & Psychophysics, 66(8), 12821292. PubMed ID: 15813194 doi:10.3758/BF03194998

    • Crossref
    • Search Google Scholar
    • Export Citation

Shafizadeh, Fowler-Davis, Lowe, Stevenson, and Davids are with Sheffield Hallam University, Sheffield, United Kingdom. Shafizadeh is also with the Academy of Sport and Physical Activity, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, United Kingdom. Manson is with the Sheffield Teaching Hospitals, Sheffield, United Kingdom. Ali is with the Brighton and Sussex Medical School, Brighton, United Kingdom. Parvinpour is with the Kharazmi University, Tehran, Iran.

Shafizadeh (m.shafizadeh@shu.ac.uk) is corresponding author.
  • Collapse
  • Expand
  • View in gallery
    Figure 1

    —Flow diagram of selection of studies focusing on environments, physical activity, and balance.

  • Alves, S.M., Gulwadi, G.B., & Cohen, U. (2006). Accommodating culturally meaningful activities in outdoor settings for older adults. Journal of Housing for the Elderly, 19(3–4), 109140. doi:10.1300/J081v19n03_07

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Aranda-Gallardo, M., Morales-Asencio, J.M., de Luna-Rodriguez, M.E., Vazquez-Blanco, M.J., Morilla-Herrera, J.C., Rivas-Ruiz, F., … Canca-Sanchez, J.C. (2018). Characteristics, consequences and prevention of falls in institutionalised older adults in the province of Malaga (Spain): A prospective, cohort, multicentre study. BMJ Open, 8(2), e020039. PubMed ID: 29476031 doi:10.1136/bmjopen-2017-020039

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Araújo, D., Davids, K., & Passos, P. (2007). Ecological validity, representative design, and correspondence between experimental task constraints and behavioral setting: Comment on Rogers, Kadar, and Costall (2005). Ecological Psychology, 19(1), 6978.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8(1), 1932. doi:10.1080/1364557032000119616

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bergen, G., Stevens, M.R., & Burns, E.R. (2016). Falls and fall injuries among adults aged ≥65 years—United States, 2014. MMWR. Morbidity and Mortality Weekly Report, 65(37), 993998. PubMed ID: 27656914 doi:10.15585/mmwr.mm6537a2

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Brand, M.T., & de Oliveira, R.F. (2017). Recalibration in functional perceptual-motor tasks: A systematic review. Human Movement Science, 56(PtB), 5470. PubMed ID: 29102772 doi:10.1016/j.humov.2017.10.020

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Campbell, A.J., Robertson, M.C., La Grow, S.J., Kerse, N.M., Sanderson, G.F., Jacobs, R.J., … Hale, L.A. (2005). Randomised controlled trial of prevention of falls in people aged ≥75 with severe visual impairment: The VIP trial. British Medical Journal, 331(7520), 817. doi:10.1136/bmj.38601.447731.55

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Cerin, E., MacFarlane, D., Sit, C., Ho, S., Johnston, J., Chou, K.L., … Ho, K. (2013). Effects of built environment on walking among Hong Kong older adults. Hong Kong Medical Journal, 19(3), S39S41.

    • Search Google Scholar
    • Export Citation
  • Chang, J.T., Morton, S.C., Rubenstein, L.Z., Mojica, W.A., Maglione, M., Suttorp, M.J., … Shekelle, P.G. (2004). Interventions for the prevention of falls in older adults: Systematic review and meta-analysis of randomised clinical trials. British Medical Journal, 328(7441), 680. doi:10.1136/bmj.328.7441.680

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Chippendale, T., & Boltz, M. (2015). The neighborhood environment: Perceived fall risk, resources, and strategies for fall prevention. Gerontologist, 55(4), 575583. PubMed ID: 24836115 doi:10.1093/geront/gnu019

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Cinderby, S., Cambridge, H., Attuyer, K., Bevan, M., Croucher, K., Gilroy, R., & Swallow, D. (2018). Co-designing urban living solutions to improve older people’s mobility and well-being. Journal of Urban Health, 95(3), 409422 PubMed ID: 29644534 doi:10.1007/s11524-018-0232-z

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Clarke, P., & Gallagher, N.A. (2013). Optimizing mobility in later life: The role of the urban built environment for older adults aging in place. Journal of Urban Health, 90(6), 9971009. PubMed ID: 23592019 doi:10.1007/s11524-013-9800-4

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Clemson, L., Stark, S., Pighills, A.C., Torgerson, D.J., Sherrington, C., & Lamb, S.E. (2019). Environmental interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 2019(2), CD013258.

    • Search Google Scholar
    • Export Citation
  • Colom, A., Ruiz, M., Wärnberg, J., Compa, M., Muncunill, J., Barón-López, F.J., … Fitó, M. (2019). Mediterranean built environment and precipitation as modulator factors on physical activity in obese mid-age and old-age adults with metabolic syndrome: Cross-sectional study. International Journal of Environmental Research and Public Health, 16(5), 854. doi:10.3390/ijerph16050854

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Cumming, R.G., Thomas, M., Szonyi, G., Salkeld, G., O’Neill, E., Westbury, C., & Frampton, G. (1999). Home visits by an occupational therapist for assessment and modification of environmental hazards: A randomized trial of falls prevention. Journal of the American Geriatrics Society, 47(12), 13971402. PubMed ID: 10591231 doi:10.1111/j.1532-5415.1999.tb01556.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Daly, R.M., Rosengren, B.E., Alwis, G., Ahlborg, H.G., Sernbo, I., & Karlsson, M.K. (2013). Gender specific age-related changes in bone density, muscle strength and functional performance in the elderly: A-10 year prospective population-based study. BMC Geriatrics, 13(1), 71. doi:10.1186/1471-2318-13-71

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Davids, K., Araújo, D., & Brymer, E. (2016). Designing affordances for health-enhancing physical activity and exercise in sedentary individuals. Sports Medicine, 46(7), 933938. PubMed ID: 26914265 doi:10.1007/s40279-016-0511-3

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Davids, K., Araújo, D., Correia, V., & Vilar, L. (2013). How small-sided and conditioned games enhance acquisition of movement and decision-making skills. Exercise and Sport Sciences Reviews, 41(3), 154161. PubMed ID: 23558693 doi:10.1097/JES.0b013e318292f3ec

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Day, L., Fildes, B., Gordon, I., Fitzharris, M., Flamer, H., & Lord, S. (2002). Randomised factorial trial of falls prevention among older people living in their own homes. British Medical Journal, 325(7356), 128128. PubMed ID: 12130606 doi:10.1136/bmj.325.7356.128

    • Crossref
    • Search Google Scholar
    • Export Citation
  • De Vriendt, P., Cornelis, E., Vanbosseghem, R., Desmet, V., & Van de Velde, D. (2019). Enabling meaningful activities and quality of life in long-term care facilities: The stepwise development of a participatory client-centred approach in Flanders. British Journal of Occupational Therapy, 82(1), 1526. doi:10.1177/0308022618775880

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Dhital, A., Pey, T., & Stanford, M.R. (2010). Visual loss and falls: A review. Eye, 24(9), 14371446. doi:10.1038/eye.2010.60

  • Engel, L., Chudyk, A., Ashe, M., McKay, H., Whitehurst, D., & Bryan, S. (2016). Older adults’ quality of life-exploring the role of the built environment and social cohesion in community-dwelling seniors on low income. Social Science & Medicine, 164, 111. PubMed ID: 27439120 doi:10.1016/j.socscimed.2016.07.008

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Fajen, B.R., & Matthis, J.S. (2011). Direct perception of action-scaled affordances: The shrinking gap problem. Journal of Experimental Psychology: Human Perception and Performance, 37(5), 14421457. PubMed ID: 21500936

    • Search Google Scholar
    • Export Citation
  • Forte, R., Pesce, C., Di Baldassarre, A., Shea, J., Voelcker-Rehage, C., Capranica, L., & Condello, G. (2019). How older adults cope with cognitive complexity and environmental constraints during dual-task walking: The role of executive function involvement. International Journal of Environmental Research and Public Health, 16(10), 1835. doi:10.3390/ijerph16101835

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gale, C.R., Cooper, C., & Aihie Sayer, A. (2016). Prevalence and risk factors for falls in older men and women: The English longitudinal study of ageing. Age and Ageing, 45(6), 789794. PubMed ID: 27496938 doi:10.1093/ageing/afw129

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gell, N.M., Rosenberg, D.E., Carlson, J., Kerr, J., & Belza, B. (2015). Built environment attributes related to GPS measured active trips in mid-life and older adults with mobility disabilities. Disability and Health Journal, 8(2), 290295. PubMed ID: 25637503 doi:10.1016/j.dhjo.2014.12.002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gibson, J. (1979). The ecological approach to visual perception. Boston, MA: Houghton, Mifflin and Company.

  • Giehl, M.W.C., Hallal, P.C., Corseuil, C.W., Schneider, I.J.C., & d’Orsi, E. (2016). Built environment and walking behavior among Brazilian older adults: A population-based study. Journal of Physical Activity & Health, 13(6), 617624. doi:10.1123/jpah.2015-0355

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gillespie, L., & Handoll, H. (2009). Prevention of falls and fall-related injuries in older people. Injury Prevention, 15(5), 354355. PubMed ID: 19805608 doi:10.1136/ip.2009.023101

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Guirguis-Blake, J.M., Michael, Y.L., Perdue, L.A., Coppola, E.L., & Beil, T.L. (2018). Interventions to prevent falls in older adults: Updated evidence report and systematic review for the US preventive services task force. Journal of the American Medical Association, 319(16), 17051716. PubMed ID: 29710140 doi:10.1001/jama.2017.21962

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hall, E., & Wilton, R. (2017). Towards a relational geography of disability. Progress in Human Geography, 41(6), 727744. doi:10.1177/0309132516659705

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hanibuchi, T., Kawachi, I., Nakaya, T., Hirai, H., & Kondo, K. (2011). Neighborhood built environment and physical activity of Japanese older adults: Results from the Aichi Gerontological Evaluation Study (AGES). BMC Public Health, 11(1), 657. doi:10.1186/1471-2458-11-657

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Huang, N.-C., Kung, S.-F., & Hu, S. (2018). The relationship between urbanization, the built environment, and physical activity among older adults in Taiwan. International Journal of Environmental Research and Public Health, 15(5), 836. doi:10.3390/ijerph15050836

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Inclusive Design for Getting Outdoors. (2006). About inclusive design for getting outdoors. Retrieved from www.idago.ac.uk

  • Janssen, H., Ada, L., Bernhardt, J., McElduff, P., Pollack, M., Nilsson, M., & Spratt, N.J. (2014). An enriched environment increases activity in stroke patients undergoing rehabilitation in a mixed rehabilitation unit: A pilot non-randomized controlled trial. Disability and Rehabilitation, 36(3), 255262. PubMed ID: 23627534 doi:10.3109/09638288.2013.788218

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kabeshova, A., Annweiler, C., Fantino, B., Philip, T., Gromov, V., Launay, C., & Beauchet, O. (2014). A regression tree for identifying combinations of fall risk factors associated to recurrent falling: A cross-sectional elderly population-based study. Aging Clinical and Experimental Research, 26(3), 331336. PubMed ID: 24781832 doi:10.1007/s40520-014-0232-0

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Keskinen, K.E., Rantakokko, M., Suomi, K., Rantanen, T., & Portegijs, E. (2018). Nature as a facilitator for physical activity: Defining relationships between the objective and perceived environment and physical activity among community-dwelling older people. Health & Place, 49, 111119. PubMed ID: 29306140 doi:10.1016/j.healthplace.2017.12.003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kolbe-Alexander, T.L., Pacheco, K., Tomaz, S.A., Karpul, D., & Lambert, E.V. (2015). The relationship between the built environment and habitual levels of physical activity in South African older adults: A pilot study. BMC Public Health, 15(1), 518. doi:10.1186/s12889-015-1853-8

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lannin, N.A., Clemson, L., McCluskey, A., Lin, C.-W.C., Cameron, I.D., & Barras, S. (2007). Feasibility and results of a randomised pilot-study of pre-discharge occupational therapy home visits. BMC Health Services Research, 7(1), 42. doi:10.1186/1472-6963-7-42

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Law, L.L., Barnett, F., Yau, M.K., & Gray, M.A. (2013). Development and initial testing of functional task exercise on older adults with cognitive impairment at risk of Alzheimer’s disease-FcTSim programme-a feasibility study. Occupational Therapy International, 20(4), 185197. PubMed ID: 23761291 doi:10.1002/oti.1355

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Law, L.L., Fong, K.N., & Yau, M.M. (2018). Can functional task exercise improve executive function and contribute to functional balance in older adults with mild cognitive impairment? A pilot study. British Journal of Occupational Therapy, 81(9), 495502. doi:10.1177/0308022618763492

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P., & Letts, L. (1996). The person-environment-occupation model: A transactive approach to occupational performance. Canadian Journal of Occupational Therapy, 63(1), 923. doi:10.1177/000841749606300103

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Leach, S.J., Maring, J.R., & Costello, E. (2019). The effects of a divided-attention timed stepping accuracy task on balance, strength, endurance, and functional performance in healthy older adults: A pilot study. Journal of Aging and Physical Activity, 27(4), 521528. PubMed ID: 30676218 doi:10.1123/japa.2018-0010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Levac, D., Colquhoun, H., & O’Brien, K.K. (2010). Scoping studies: Advancing the methodology. Implementation Science, 5(1), 69. doi:10.1186/1748-5908-5-69

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Levasseur, M., Généreux, M., Bruneau, J., Vanasse, A., Chabot, É., Beaulac, C., & Bédard, M.-M. (2015). Importance of proximity to resources, social support, transportation and neighborhood security for mobility and social participation in older adults: Results from a scoping study. BMC Public Health, 15(1), 503. PubMed ID: 26002342 doi:10.1186/s12889-015-1824-0

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Li, F., Fisher, K.J., Brownson, R.C., & Bosworth, M. (2005). Multilevel modelling of built environment characteristics related to neighbourhood walking activity in older adults. Journal of Epidemiology & Community Health, 59(7), 558564. PubMed ID: 15965138 doi:10.1136/jech.2004.028399

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lin, M.R., Wolf, S.L., Hwang, H.F., Gong, S.Y., & Chen, C.Y. (2007). A randomized, controlled trial of fall prevention programs and quality of life in older fallers. Journal of the American Geriatrics Society, 55(4), 499506. PubMed ID: 17397426 doi:10.1111/j.1532-5415.2007.01146.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Liu, C.-J., Jones, L.Y., Formyduval, A.R., & Clark, D.O. (2016). Task-oriented exercise to reduce activities of daily living disability in vulnerable older adults: A feasibility study of the 3-step workout for life. Journal of Aging & Physical Activity, 24(3), 384392. doi:10.1123/japa.2015-0070

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Logan, D., Kiemel, T., Dominici, N., Cappellini, G., Ivanenko, Y., Lacquaniti, F., & Jeka, J.J. (2010). The many roles of vision during walking. Experimental Brain Research, 206(3), 337350. PubMed ID: 20852990 doi:10.1007/s00221-010-2414-0

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lu, Y., Chen, L., Yang, Y., & Gou, Z. (2018). The association of built environment and physical activity in older adults: Using a citywide public housing scheme to reduce residential self-selection bias. International Journal of Environmental Research and Public Health, 15(9), 1973. doi:10.3390/ijerph15091973

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lu, Y.Y.F., Bakas, T., Yang, Z., Weaver, M.T., Austrom, M.G., & Haase, J.E. (2016). Feasibility and effect sizes of the revised daily engagement of meaningful activities intervention for individuals with mild cognitive impairment and their caregivers. Journal of Gerontological Nursing, 42(3), 4558. PubMed ID: 26934973 doi:10.3928/00989134-20160212-08

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mazzei, F., Gillan, R., & Cloutier, D. (2014). Exploring the influence of environment on the spatial behavior of older adults in a purpose-built acute care dementia unit. American Journal of Alzheimer’s Disease & Other Dementias, 29(4), 311319. PubMed ID: 32417775 doi:10.1177/1533317513517033

    • Crossref
    • Search Google Scholar
    • Export Citation
  • McDonald, M.W., Hayward, K.S., Rosbergen, I.C., Jeffers, M.S., & Corbett, D. (2018). Is environmental enrichment ready for clinical application in human post-stroke rehabilitation? Frontiers in Behavioral Neuroscience, 12, 135. PubMed ID: 30050416 doi:10.3389/fnbeh.2018.00135

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Melzer, I., Kurz, I., & Oddsson, L.I. (2010). A retrospective analysis of balance control parameters in elderly fallers and non-fallers. Clinical Biomechanics, 25(10), 984988. PubMed ID: 20696509 doi:10.1016/j.clinbiomech.2010.07.007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Menuchi, M.R.T.P., & Gobbi, L.T.B. (2012). Optic flow contribution to locomotion adjustments in obstacle avoidance. Motor Control, 16(4), 506520. doi:10.1123/mcj.16.4.506

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mesbah, N., Perry, M., Hill, K.D., Kaur, M., & Hale, L. (2017). Postural stability in older adults with Alzheimer disease. Physical Therapy, 97(3), 290309. PubMed ID: 28204720

    • Search Google Scholar
    • Export Citation
  • Nagel, C.L., Carlson, N.E., Bosworth, M., & Michael, Y.L. (2008). The relation between neighborhood built environment and walking activity among older adults. American Journal of Epidemiology, 168(4), 461468. PubMed ID: 18567638 doi:10.1093/aje/kwn158

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Nicholson, V.P., McKean, M.R., & Burkett, B.J. (2014). Twelve weeks of BodyBalance® training improved balance and functional task performance in middle-aged and older adults. Clinical Interventions in Aging, 9, 1895. PubMed ID: 25395844 doi:10.2147/CIA.S71769

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Nikolaus, T., & Bach, M. (2003). Preventing falls in community-dwelling frail older people using a home intervention team (HIT): Results from the randomized Falls-HIT trial. Journal of the American Geriatrics Society, 51(3), 300305. PubMed ID: 12588572 doi:10.1046/j.1532-5415.2003.51102.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Nithianantharajah, J., & Hannan, A.J. (2006). Enriched environments, experience-dependent plasticity and disorders of the nervous system. Nature Reviews Neuroscience, 7(9), 697709. PubMed ID: 16924259 doi:10.1038/nrn1970

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Nyberg, L., & Gustafson, Y. (1995). Patient falls in stroke rehabilitation: A challenge to rehabilitation strategies. Stroke, 26(5), 838842. PubMed ID: 7740577 doi:10.1161/01.STR.26.5.838

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Paquette, M.R., & Vallis, L.A. (2010). Age-related kinematic changes in late visual-cueing during obstacle circumvention. Experimental Brain Research, 203(3), 563574. PubMed ID: 20467732 doi:10.1007/s00221-010-2263-x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Pardessus, V., Puisieux, F., Di Pompeo, C., Gaudefroy, C., Thevenon, A., & Dewailly, P. (2002). Benefits of home visits for falls and autonomy in the elderly: A randomized trial study. American Journal of Physical Medicine & Rehabilitation, 81(4), 247252. PubMed ID: 11953541 doi:10.1097/00002060-200204000-00002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Parra, D.C., Gomez, L.F., Fleischer, N.L., & Pinzon, J.D. (2010). Built environment characteristics and perceived active park use among older adults: Results from a multilevel study in Bogota. Health & Place, 16(6), 11741181. PubMed ID: 20708426 doi:10.1016/j.healthplace.2010.07.008

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Pedroso, R.V., Ayán, C., Fraga, F.J., da Silva, T.M., Cancela, J.M., & Santos-Galduròz, R.F. (2018). Effects of functional-task training on older adults with Alzheimer’s disease. Journal of Aging and Physical Activity, 26(1), 97105. PubMed ID: 28513303 doi:10.1123/japa.2016-0147

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Perell, K.L., Nelson, A., Goldman, R.L., Luther, S.L., Prieto-Lewis, N., & Rubenstein, L.Z. (2001). Fall risk assessment measures: An analytic review. The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 56(12), M761M766. doi:10.1093/gerona/56.12.M761

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Pighills, A., Drummond, A., Crossland, S., & Torgerson, D.J. (2019). What type of environmental assessment and modification prevents falls in community dwelling older people? British Medical Journal, 364, l880. PubMed ID: 30872322 doi:10.1136/bmj.l880

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Pighills, A.C., Torgerson, D.J., Sheldon, T.A., Drummond, A.E., & Bland, J.M. (2011). Environmental assessment and modification to prevent falls in older people. Journal of the American Geriatrics Society, 59(1), 2633. PubMed ID: 21226674 doi:10.1111/j.1532-5415.2010.03221.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Public Health England. (2017). Falls and fracture consensus statement: Supporting commissioning for prevention. National falls prevention coordination group report. London, UK: PHE Publications Gateway.

    • Search Google Scholar
    • Export Citation
  • Qiu, F., Cole, M.H., Davids, K., Hennig, E., Silburn, P., Netscher, H., & Kerr, G. (2012). Enhanced somatosensory information decreases postural sway in older people. Gait & Posture, 35(4), 630635. PubMed ID: 22245163 doi:10.1016/j.gaitpost.2011.12.013

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rensink, M., Schuurmans, M., Lindeman, E., & Hafsteinsdóttir, T. (2009). Falls: Incidence and risk factors after stroke. A systematic literature review. Tijdschrift Voor Gerontologie en Geriatrie, 40(4), 156167. PubMed ID: 20088342 doi:10.1007/BF03079581

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rosbergen, I.C., Grimley, R.S., Hayward, K.S., & Brauer, S.G. (2019). The impact of environmental enrichment in an acute stroke unit on how and when patients undertake activities. Clinical Rehabilitation, 33(4), 784795. PubMed ID: 30582368 doi:10.1177/0269215518820087

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rosbergen, I.C., Grimley, R.S., Hayward, K.S., Walker, K.C., Rowley, D., Campbell, A.M., … Janssen, H. (2017). Embedding an enriched environment in an acute stroke unit increases activity in people with stroke: A controlled before-after pilot study. Clinical Rehabilitation, 31(11), 15161528. PubMed ID: 28459184 doi:10.1177/0269215517705181

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rosenbaum, D.A. (2010). Human motor control. London, UK: Elsevier.

  • Rumrill, P.D., Fitzgerald, S.M., & Merchant, W.R. (2010). Using scoping literature reviews as a means of understanding and interpreting existing literature. Work, 35(3), 399404.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Sánchez, C.C., Murillo, D.B., Davids, K., & Hernández, F.J.M. (2016). Variations in task constraints shape emergent performance outcomes and complexity levels in balancing. Experimental Brain Research, 234(6), 16111622. PubMed ID: 26838357 doi:10.1007/s00221-016-4563-2

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Sato, M., Inoue, Y., Du, J., & Funk, D.C. (2019). Access to parks and recreational facilities, physical activity, and health care costs for older adults: Evidence from US counties. Journal of Leisure Research, 50(3), 220238. doi:10.1080/00222216.2019.1583048

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Scuffham, P., Chaplin, S., & Legood, R. (2003). Incidence and costs of unintentional falls in older people in the United Kingdom. Journal of Epidemiology & Community Health, 57(9), 740744. PubMed ID: 12933783 doi:10.1136/jech.57.9.740

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Soma, Y., Tsunoda, K., Kitano, N., Jindo, T., Tsuji, T., Saghazadeh, M., & Okura, T. (2017). Relationship between built environment attributes and physical function in Japanese community-dwelling older adults. Geriatrics & Gerontology International, 17(3), 382390. PubMed ID: 26800502 doi:10.1111/ggi.12717

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Stephens, L., Ruddick, S., & McKeever, P. (2015). Disability and Deleuze: An exploration of becoming and embodiment in children’s everyday environments. Body & Society, 21(2), 194220. doi:10.1177/1357034X14541155

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Stevens, M., Holman, C.D.A.J., Bennett, N., & De Klerk, N. (2001). Preventing falls in older people: Outcome evaluation of a randomized controlled trial. Journal of the American Geriatrics Society, 49(11), 14481455. PubMed ID: 11890582 doi:10.1046/j.1532-5415.2001.4911236.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Talbot, L.A., Musiol, R.J., Witham, E.K., & Metter, E.J. (2005). Falls in young, middle-aged and older community dwelling adults: Perceived cause, environmental factors and injury. BMC Public Health, 5(1), 86. doi:10.1186/1471-2458-5-86

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Timmermans, E.J., Schaap, L.A., Visser, M., van der Ploeg, H.P., Wagtendonk, A.J., van der Pas, S., & Deeg, D.J. (2016). The association of the neighbourhood built environment with objectively measured physical activity in older adults with and without lower limb osteoarthritis. BMC Public Health, 16(1), 710. doi:10.1186/s12889-016-3347-8

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Winters, M., Barnes, R., Venners, S., Ste-Marie, N., McKay, H., Sims-Gould, J., & Ashe, M. (2015). Older adults’ outdoor walking and the built environment: Does income matter? BMC Public Health, 15(1), 876. doi:10.1186/s12889-015-2224-1

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Withagen, R., & Michaels, C.F. (2004). Transfer of calibration in length perception by dynamic touch. Perception & Psychophysics, 66(8), 12821292. PubMed ID: 15813194 doi:10.3758/BF03194998

    • Crossref
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 2432 393 0
Full Text Views 1387 1319 277
PDF Downloads 317 255 48