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Physical Activity and the Built Environment (INTRO : Obesity, lack of…

- - - - While it is accepted obesity is influenced by genetic and behavioural factors, the environmental influences have yet to be fully explored and understood (Jackson, 2003)
        
        Many investigators have attempted to explain the obesity epidemic, yet no single theory has sufficiently explained all of the factors contributing to overweight and obesity.
        For instance, while genes may increase susceptibility for obesity, no dominant genes have been discovered whose presence is necessary or sufficient to cause obesity (Bouchard, 1995).
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      - A novel and longer-term approach would be to investigate the environments that promote high energy intake and sedentary behaviour; this has not yet been fully understood. If the influences of these environments were understood, approaches that modify the environment would have the potential to assist in the prevention of this multifactorial disease.
- - - - Despite the emphasis on understanding and intervening on individual characteristics that influence dietary and physical activity patterns (Giles-Corti & Donovan, 2003), little progress has been made in stemming the obesity epidemic. As a result, researchers also have begun to focus on the interaction between environmental factors and the development of overweight and obesity.
        
        Human environments are enormously complex, thus warrant a multidisciplinary approach to investigate this concept of obesogenic environments. Obesity = not caused by a single factor. The environment has a significant effect on diet, physical activity and obesity
    - - In a review of environmental and policy approaches to promote physical activity, Sallis, Bauman, and Pratt (1998) concluded that research into environmental and policy interventions have been hampered by a lack of conceptual models and difficulties
        inherent in dissecting environmental variables on individual behavior.
        
        Incentives for activity + education = physical activity
        
        Safety (e.g. cycle lane), Availability/Access, Support for personal transport/ activities --> require supportive environment --> physical activity
  - - - Less take aways, more fruits and veg. Less sugar + fat
    - - Active travel, going to gym, generally more active
    - - take breaks from sitting, less sedentary behaviour
    - - Target outcome: prevalence of overweight people decreases
        
        Main aetoilogical mechanism: environmental, behavioural, cultural (Individual based approach would be more like genetics and metabolic)
- - - - Morland et al. (2002): 3x as many supermarkets (e.g., defined as having the healthiest food options compared with other food stores existed in the wealthier neighborhoods, though more convenience stores, small grocery stores, and specialty food stores were in the lower wealth neighborhoods). Further, fast food restaurants were more prevalent in the lower and medium wealth neighborhoods than in the higher wealth neighborhoods. For comparisons by race, results indicated that more Black residents lived in lower SES neighborhoods than did White residents, and four times as many supermarkets were located in White neighborhoods than in Black neighborhoods. Unfortunately, they did not collect data on obesity risk, so they were unable to demonstrate a relationship between the differences in the socioeconomic distribution of food sources and obesity risk and SES stratification.
- - - - Individual level interventions can often be more informative, however population-environmental based ones have huge benefits
        
        behaivour becomes systematic: Changing the physical environment for recreation, food laws, local government transport policies, etc., embeds the changes into the system
        
        Likely to be sustained: Systemic changes such as safe, attractive cycle networks or healthy school-food menus, which are backed by strong policies and traditions, are more likely than media campaigns to sustain behaviours over the long term
        
        Hard to reach areas: low SES areas that do not tend to respond to health interventions, but a new park in the area may help them
- - - - Support: Neighbourhoods are a key setting for active recreation. These encompass the walking network (footpaths and walking tracks), the cycling network (roads and cycle paths), informal open recreation spaces (such as parks) and formal recreation facilities (such as sports grounds or recreation centres). Several studies have found that higher levels of recreational activity correlate with the proximity, density, attractiveness and safety of recreation facilities of spaces (Rutten et al. 2001).
        
        BUT - SELF SELECTION BIAS!Most of these have been cross-sectional or qualitative studies, and self-selection bias (individuals motivated to do physical activity choosing to live in areas with
        good access to recreation facilities) probably accounts for part of these relationships. (Brownson et al, 2000)
        
        ALSO : increasing the amount of open recreational
        space is difficult within an existing built environment.
        
        protecting the loss of such spaces requires a strong culture within local government of ‘green preservation’ against perpetual commercial pressures. There are a wide variety of enhancements of recreational spaces available to local governments, such as extending walking and cycle paths, adding facilities such as skateboard ramps, increasing lighting, increasing attractiveness and reducing crime rates in the area. Increasing the availability and access to active recreational opportunities were strongly recommended in the CDC (Centres of Disease Contol and Prevention, 2001)
    - - Low density can increase distances between origins and destinations. Its relationship to travel is intuitive ñ higher density levels reduce trip distances, theoretically increasing the incentive to walk and bike ñ and its measurement is simple. For these reasons, density is perhaps the most-studied land development variable. Much of the research on density and travel has centered on motorized travel modes.
    - - FRANK ET AL. (2001): carried out a review desmontrating that land development patterns and mode of transport are highly related, and have profound effects on physical activity levels.
        
        Public transport involves more physical activity than cars due to short walking trips. America is car-orientated
        
        In USA = 10% of trips = walking/cycling
        
        In some European countries = walk + cycle > cars
        
        DOES THIS EXPLAIN OBESITY DIFFERENCE?
        
        Interventions
        
        Pedestrian and cycle friendly design. Design of streets and areas in the central business districts as car free (Crawford, 2000)
        
        Linenger, Chesson, and Nice (1991) assessed changes in
        physical fitness levels after changes were made to a San Diego naval air station community and compared them to those at a similar community that hadnít made changes.
        
        The main objective of the interventions at the San Diego station was to improve levels of physical activity by reducing or removing environmental barriers. Some changes included the construction of bicycle paths, the extension of hours at recreation facilities, the installation of new exercise equipment at the stationís gym, the organization of running and cycling clubs, and the creation of institutional support and rewards for physical activity. The results of the study found significantly greater levels of physical fitness at the intervention community.
  - - - Choice architecture: the ways in which choice (and associated outcome) can be influenced by the way in which choices are presented.
        
        • It can be appealing to politicians and policy makers as it does not coerce people, who still have a choice (e.g. change defaults) - so less likely to generate hostility from the public.
      - Thaler and Sunstein define a ‘nudge’ as “any aspect of the choice architecture that alters people’s behaviour in a predictable way without forbidding any options or significantly changing their economic incentives”.
        
        Active nudging
        
        A sign saying 'burn calories not electricity'.
        
        Have been shown to increase stair walking (Russel et al 1999) Called a POINT OF DECISION PROMPT
        
        Implementation of such signs could be very beneficial
        
        •Stair climbing uses 9.6 times the energy of the resting state, i.e., requires more energy per minute than jogging or rowing (Teh and Aziz, 2002).
        •Just two minutes of stair-climbing each day burns enough calories to eliminate the one pound an average US adult gains each year
        
        passive nudging
        
        Visual triggers: priming
        
        Stairs need to be attractive, easy option for everyday use. e.g. place lines on the floor which direct people towards the stairs as opposed to the lift. Make stairs more visible
        
        Fun Theory - e..g Volkswagen turned the stairs into piano keys
        
        Standing desk
        
        Gym/ + showers in office
        
        Healthy food options