Table 2 shows the mean ± SD of each environmental attribute and the odds of regular walking (cross-sectional) and of maintaining regular walking (prospective) for each environmental attribute, adjusting for the covariates discussed above. Most of these environmental attributes were not closely correlated, except for a few moderate correlations (r < 0.5; see Table, Supplemental Digital Content 1, Pearson’s correlation coefficients between environmental attributes, http://links.lww.com/MSS/A446). Cross-sectional analyses found that having many stores, having many alternative routes, having a park or nature reserve, having bicycle or walkway tracks, and feeling safe to walk during the day in their neighborhood were associated with a higher likelihood of being a regular walker at baseline. Prospective analyses found that participants who had many alternative routes in their local area were more likely to maintain regular walking at follow-up. In analyses using the alternative walking categorization, regular walking was associated with the same environmental attributes and with having pleasant natural features in the neighborhood. Having multiple alternative routes was also associated with regular walking maintenance for the alternative categorization.
A significant interaction with work change status was found for having many alternative routes (P = 0.07) in cross-sectional analyses. In prospective analyses, interactions with work change status were significant for having many alternative routes (P = 0.08), footpaths (P = 0.03), a park and nature reserve (P = 0.04), and bicycle or walkway tracks (P = 0.02). The results of stratified analyses for these variables are shown in Table 3. Having many alternative routes was associated with regular walking as well as the maintenance of regular walking only among “nonworking” participants (those who were not working or had stopped working). Having bicycle or walkway tracks nearby was associated with the maintenance of regular walking only among nonworking participants. For the other environmental attributes, stratified analyses showed that the two groups differed in the direction of associations (negative associations for those who kept working, positive associations for nonworking participants), but the relationships were not statistically significant. For the alternative walking categorization, no significant interaction was found in cross-sectional analyses, but the same pattern of moderations was found for regular walking maintenance.
In this cohort of Australian adults, neighborhood environmental attributes associated prospectively with the maintenance of walking were found to be different from correlates of walking identified in cross-sectional analyses. Having many alternative routes (i.e., high street connectivity) was the only environmental attribute that was commonly associated cross-sectionally and prospectively. Access to bicycle and walking tracks was associated with regular walking at baseline for the whole sample and with the maintenance of walking only among those who did not work or had stopped working. These findings were also observed for the alternative categorization of regular and nonregular walking. Three environmental attributes, namely, the presence of footpaths, attractiveness, and local traffic, were associated neither with regular walking nor with walking maintenance. Differences between cross-sectional and prospective analyses were observed for the following attributes: having many stores nearby, having open spaces such as parks, and feeling safe to walk during the day. These were significantly associated cross-sectionally with regular walking but not with the maintenance of regular walking. The findings of having stores nearby are consistent with existing cross-sectional studies reporting the relevance of nonresidential destinations to walking (16,19,22,32). Studies on safety from crime and physical activity have reported mixed findings (9), yet there are some recent studies that have shown positive associations between perceived safety from crime and walking (6,30). These findings suggest that some environmental correlates of walking identified in the existing cross-sectional studies may not necessarily help adult residents to maintain their walking over a period of time.
It may be argued from the present findings that pedestrian or route environments (alternative routes, walking trails) may be important to encourage long-term maintenance of regular walking, whereas both destinations (stores, parks) and pedestrian environments (alternative routes, walking trails, and safety from crime) are relevant to regular walking at one point in time. An obvious question is why environmental attributes that are associated cross-sectionally with walking are not related to walking maintenance. For instance, why was the presence of stores, which has been consistently shown as a correlate of walking, not associated with maintenance? Our findings do not provide an empirical answer to this question. However, it may be that those who maintained walking over a period of time have established a habit of walking, and habitual and nonhabitual walking may be influenced by different environmental factors. For habitual walkers, what matters may be the availability of walkable pedestrian environments. On the other hand, for nonhabitual or occasional walkers, decisions to walk may be dependent more on the presence of places to walk to. It has been shown that motivational/attitudinal factors are relevant to the maintenance of physical activity (4). Further research exploring individual, social, and environmental factors that would contribute to adults’ walking habit is warranted.
It was found that having many alternative routes and access to walking tracks were the only environmental attributes relevant both to regular walking and to maintenance of regular walking. Intersection density was found to be associated with walking in previous cross-sectional studies (17,36). Stratified analyses found that significant associations of having many alternative routes with walking were observed for participants who stopped or were not working. The pronounced association for nonworkers or those who had stopped working was obtained perhaps because they tended to be more exposed to local environments. However, it is not totally clear whether well-connected street network is conducive to regular walking and to walking maintenance simply because of the availability of more direct route options or because of other environmental or social factors that coexist with higher street connectivity. A study examining the mechanisms through which street connectivity influences walking could provide useful insights into how to facilitate walking maintenance. Walking trails seem to be an important resource to support regular walking. Recent natural experiments have found an increase in walking after an urban trail was built or retrofıtted (7,35). However, research on this type of walking facility is relatively limited compared to studies on neighborhood walkability or on public open spaces. Further studies on attributes of walking trails that can contribute to habitual walking will provide relevant information that helps promote walking through the increased use of this resource.
Limitations and Strengths
Several limitations need to be considered in interpreting the present findings and identifying fruitful directions for future research. Walking categories were created using a self-report question with a short timeframe (the last 7 d) at baseline and at follow-up. Fluctuation in walking behaviors that could have occurred during the study period may have led to misclassification of participants. In addition, regular walking and walking maintenance were determined using the cut point of five times per week, which corresponds to current physical activity guidelines (11). Although the alternative categorization produced similar results, these categories may have also misclassified participants. Measures that can accurately characterize long-term patterns of walking need to be developed.
The walking measure used for the study incorporated both walking for transportation and for recreation. Review articles show consistently that these walking domains are associated with different environmental attributes because they tend to take place in different settings (26,32). Thus, it is possible that combining them has masked the relationship between a specific type of walking and an attribute that may actually have existed. A further limitation is that there may have been some environmental changes between baseline and follow-up. A recent longitudinal study has shown increases in recreational facilities around home to be associated with a less pronounced decline in recreational physical activity (24). However, it is unlikely that such changes happened in a systematic way across study areas (e.g., areas with more destinations where people walked regularly at baseline lost destinations at follow-up).
Participants who have a habit of walking may have chosen to live in a local area with particular attributes. A cross-sectional study found that both neighborhood walkability and attitudes toward active travel accounted for residents’ walking behaviors (10). However, the effect of self-selection and attitudinal factors on a long-term walking pattern needs to be examined in future prospective studies. Further, a relatively small number of environmental attributes were used in the study, and they may have missed some relevant environmental characteristics. The response options for these items were four integers (1, 2, 3, and 4), which may be a metric that is too crude for examining complex relationships (e.g., nonlinear associations) between environmental attributes and walking outcomes. In addition, there may be other interpersonal, intrapersonal, and area-level characteristics (e.g., attitude toward activity, social ties, social norms) that may have confounded the relationships between walking and environmental attributes.
The strengths of this study include its large sample size, longitudinal design, and consideration of the change in life circumstances (work status, household composition). Because participants were recruited from diverse locations (urban, suburban, and regional) throughout Australia, our findings may be applicable to broader settings in a similar context. However, the generalizability of the findings to localities with different environmental characteristics (e.g., Europe or Asia with higher residential density) remains to be determined. We have also used multiple criteria to exclude participants who were likely to have difficulty walking around to minimize the inclusion of participants who stopped walking because of a decline in functional capacity.
In summary, this study found that neighborhood environmental attributes associated cross-sectionally with adults’ regular walking were not necessarily related to the maintenance of regular walking. Our findings suggest that better pedestrian environments (well-connected street network, access to walking trails) may contribute to the maintenance of walking behavior. Given the importance of long-term habitual walking for health benefits, more prospective studies are needed to further explicate these relationships.
The AusDiab study was co-coordinated by the Baker IDI Heart and Diabetes Institute. We gratefully acknowledge the support and assistance given by: K. Anstey, B. Atkins, B. Balkau, E. Barr, A. Cameron, S. Chadban, M. de Courten, A. Kavanagh, D. Magliano, S. Murray, K. Polkinghorne, J. Shaw, T. Welborn, P. Zimmet, and all the study participants. For funding or logistical support, the authors thank the National Health and Medical Research Council (NHMRC; nos. 233200 and 1007544), Australian Government Department of Health and Ageing, Abbott Australasia Pty Ltd., Alphapharm Pty Ltd., Amgen Australia, AstraZeneca, Bristol-Myers Squibb, City Health Centre – Diabetes Service – Canberra, Department of Health and Community Services – Northern Territory, Department of Health and Human Services – Tasmania, Department of Health – New South Wales, Department of Health – Western Australia, Department of Health – South Australia, Department of Human Services – Victoria, Diabetes Australia, Diabetes Australia Northern Territory, Eli Lilly Australia, Estate of the Late Edward Wilson, GlaxoSmithKline, Jack Brockhoff Foundation, Janssen-Cilag, Kidney Health Australia, Marian & FH Flack Trust, Menzies Research Institute, Merck Sharp & Dohme, Novartis Pharmaceuticals, Novo Nordisk Pharmaceuticals, Pfizer Pty Ltd., Pratt Foundation, Queensland Health, Roche Diagnostics Australia, Royal Prince Alfred Hospital, Sydney, Sanofi Aventis, and sanofi-synthelabo. M.J.K. was supported by NHMRC Program Grant no. 569940. J.S. was supported by NHMRC Principal Research Fellowship no. 1026216. D.W.D. was supported by Australian Research Council Future Fellowship. N.O. was supported by NHMRC Program Grant no. 569940 and NHMRC Senior Principal Research Fellowship no. 1003960. Authors from Baker IDI Heart and Diabetes Institute were supported by the Victorian Government’s Operational Infrastructure Support Program.
All authors declare no conflict of interest. The results of the present study do not constitute endorsement by the American College of Sports Medicine.
3. Brown WJ, Burton NW, Marshall AL, Miller YD. Reliability and validity of a modified self-administered version of the Active Australia physical activity
survey in a sample of mid-age women. Aust N Z J Public Health
. 2008; 32 (6): 535–41.
4. Conroy DE, Hyde AL, Doerksen SE, Ribeiro NF. Implicit attitudes and explicit motivation prospectively predict physical activity
. Ann Behav Med
. 2010; 39 (2): 112–8.
5. Dunstan DW, Zimmet PZ, Welborn TA, et al. The Australian Diabetes, Obesity and Lifestyle Study (AusDiab): methods and response rates. Diabetes Res Clin Pract
. 2002; 57 (2): 119–29.
6. Evenson KR, Block R, Roux AVD, McGinn AP, Wen F, Rodriguez DA. Associations of adult physical activity
with perceived safety and police-recorded crime: the Multi-Ethnic Study of Atherosclerosis. Int J Behav Nutri Phys Activ
. 2012; 9: 146.
7. Fitzhugh EC, Bassett DR Jr, Evans MF. Urban trails and physical activity
: a natural experiment. Am J Prev Med
. 2010; 39 (3): 259–62.
8. Forsyth A, Oakes JM, Lee B, Schmitz KH. The built environment, walking, and physical activity
: is the environment more important to some people than others? Transport Res D-Tr E
. 2009; 14 (1): 42–9.
9. Foster S, Giles-Corti B. The built environment, neighborhood crime and constrained physical activity
: an exploration of inconsistent findings. Prev Med
. 2008; 47 (3): 241–51.
10. Frank LD, Saelens BE, Powell KE, Chapman JE. Stepping towards causation: do built environments or neighborhood and travel preferences explain physical activity
, driving, and obesity? Soc Sci Med
. 2007; 65 (9): 1898–914.
11. Garber CE, Blissmer B, Deschenes MR, et al. American College of Sports Medicine Position Stand: quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc
. 2011; 43 (7): 1334–59.
12. Gauvin L, Richard L, Kestens Y, et al. Living in a well-serviced urban area is associated with maintenance of frequent walking among seniors in the VoisiNuAge Study. J Gerontol B Psychol Sci Soc Sci
. 2012; 67 (1): 76–88.
13. Kruger J, Ham SA, Berrigan D, Ballard-Barbash R. Prevalence of transportation and leisure walking among US adults. Prev Med
. 2008; 47 (3): 329–34.
14. Lee IM, Buchner DM. The importance of walking to public health. Med Sci Sports Exerc
. 2008; 40 (7 Suppl): S512–8.
15. Li FZ, Fisher KJ, Brownson RC. A multilevel analysis of change in neighborhood walking activity in older adults. J Aging Phys Activ
. 2005; 13 (2): 145–59.
16. Li FZ, Fisher KJ, Brownson RC, Bosworth M. Multilevel modelling of built environment characteristics related to neighbourhood walking activity in older adults. J Epidemiol Community Health
. 2005; 59 (7): 558–64.
17. Marshall WE, Garrick NW. Effect of street network design on walking and biking. Transp Res Record
. 2010; 2198: 103–15.
18. Mason P, Kearns A, Livingston M. “Safe Going”: the influence of crime rates and perceived crime and safety on walking in deprived neighbourhoods. Soc Sci Med
. 2013; 91 (1): 15–24.
19. McCormack GR, Giles-Corti B, Bulsara M. The relationship between destination proximity, destination mix and physical activity
behaviors. Prev Med
. 2008; 46 (1): 33–40.
20. Merom D, van der Ploeg HP, Corpuz G, Bauman AE. Public health perspectives on household travel surveys: active travel between 1997 and 2007. Am J Prev Med
. 2010; 39 (2): 113–21.
21. Murtagh EM, Murphy MH, Boone-Heinonen J. Walking: the first steps in cardiovascular disease prevention. Curr Opin Cardiol
. 2010; 25 (5): 490–6.
22. Nathan A, Pereira G, Foster S, Hooper P, Saarloos D, Giles-Corti B. Access to commercial destinations within the neighbourhood and walking among Australian older adults. Int J Behav Nutri Phys Activ
. 2012; 9: 133.
23. Owen N, Humpel N, Leslie E, et al. Understanding environmental influences on walking: review and research agenda. Am J Prev Med
. 2004; 27 (1): 67–76.
24. Ranchod YK, Diez Roux AV, Evenson KR, Sanchez BN, Moore K. Longitudinal associations between neighborhood recreational facilities and change in recreational physical activity
in the Multi-Ethnic Study of Atherosclerosis, 2000–2007. Am J Epidemiol
. 2014; 179 (3): 335–43.
25. Rzewnicki R, Vanden Auweele Y, De Bourdeaudhuij I. Addressing overreporting on the International Physical Activity
Questionnaire (IPAQ) telephone survey with a population sample. Public Health Nutr
. 2003; 6 (3): 299–305.
26. Saelens BE, Handy SL. Built environment correlates of walking: a review. Med Sci Sports Exerc
. 2008; 40 (7): S550–66.
27. Saelens BE, Sallis JF, Frank LD. Environmental correlates of walking and cycling: findings from the transportation, urban design, and planning literatures. Ann Behav Med
. 2003; 25 (2): 80–91.
28. Sallis JF, Owen N, Fisher EB. Ecological models of health behavior. In: Glanz K, Rimer BK, Viswanath K, eds. Health Behavior and Health Education: Theory, Research, and Practice
, 4th ed, San Francisco (CA): Jossey-Bass, 2008: 465–86.
29. Stessman J, Hammerman-Rozenberg R, Cohen A, Ein-Mor E, Jacobs JM. Physical activity
, function, and longevity among the very old. Arch Intern Med
. 2009; 169 (16): 1476–83.
30. Sugiyama T, Cerin E, Owen N, et al. Perceived neighbourhood environmental attributes associated with adults’ recreational walking: IPEN Adult study in 12 countries. Health Place
. 2014; 28: 22–30.
31. Sugiyama T, Giles-Corti B, Summers J, du Toit L, Leslie E, Owen N. Initiating and maintaining recreational walking: a longitudinal study on the influence of neighborhood green space. Prev Med
. 2013; 57 (3): 178–82.
32. Sugiyama T, Neuhaus M, Cole R, Giles-Corti B, Owen N. Destination and route attributes associated with adults’ walking: a review. Med Sci Sports Exerc
. 2012; 44 (7): 1275–86.
33. Thorp AA, Healy GN, Owen N, et al. Deleterious associations of sitting time and television viewing time with cardiometabolic risk biomarkers: Australian Diabetes, Obesity and Lifestyle (AusDiab) study 2004–2005. Diabetes Care
. 2010; 33 (2): 327–34.
34. Van Holle V, Deforche B, Van Cauwenberg J, et al. Relationship between the physical environment and different domains of physical activity
in European adults: a systematic review. BMC Public Health
. 2012; 12: 807.
35. West ST, Shores KA. The impacts of building a greenway on proximate residents’ physical activity
. J Phys Activ Health
. 2011; 8 (8): 1092–7.
36. Wilson L-AM, Giles-Corti B, Burton NW, Giskes K, Haynes M, Turrell G. The association between objectively measured neighborhood features and walking in middle-aged adults. Am J Health Promot
. 2011; 25 (4): e12–21.
PHYSICAL ACTIVITY; ADHERENCE; CROSS-SECTIONAL STUDIES; PROSPECTIVE STUDIES
Supplemental Digital Content
© 2015 American College of Sports Medicine