Association between neighborhood walkability, cardiorespiratory fitness and body-mass index.
Many studies have found cross-sectional associations between characteristics of the neighborhood built environment and physical activity (PA) behavior. However, most are based on self-reported PA, which is known to result in overestimation of PA and differential misclassification by demographic and biological characteristics. Cardiorespiratory fitness (CRF) is an objective marker of PA because it is primarily determined by PA. Furthermore, it is causally related to long-term health outcomes. Therefore, analyses of the association between CRF and built environment could strengthen arguments for the importance of built environment influences on health. We examined the association between neighborhood walkability and CRF and body-mass index (BMI). This cross-sectional analysis included 16,543 adults (5017 women, 11,526 men) aged 18-90 years with home addresses in Texas who had a comprehensive clinical examination between 1987 and 2005. Outcomes included CRF from total duration on a maximal exercise treadmill test and measured BMI. Three neighborhood walkability factors emerged from principal components analyses of block-group measures derived from the U.S. Census. In multilevel adjusted analyses, the neighborhood walkability factors were significantly associated with CRF and BMI among men and women in the expected direction. An interaction between one of the neighborhood factors and age was also observed. The interaction suggested that living in neighborhoods with older homes and with residents traveling shorter distances to work was more strongly positively associated with CRF among younger adults and more strongly negatively associated with BMI among older adults. In conclusion, neighborhood characteristics hypothesized to support more PA and less driving were associated with higher levels of CRF and lower BMI. Demonstration of an association between built environment characteristics and CRF is a significant advance over past studies based on self-reported PA. Nevertheless, stronger causal evidence depends on more robust study designs and sophisticated measures of the environment, behavior, and their physiological consequences.
Division of Public Health Sciences, Department of Surgery and Alvin J. Siteman Cancer Center, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8100, Washington University in St. Louis, MO 63110, USA. hoehnerc@wudosis.wustl.edu
Christine M
CM
Hoehner
Susan L
SL
Handy
Yan
Y
Yan
Steven N
SN
Blair
David
D
Berrigan
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D004779:Environment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity; D010809:Physical Fitness / Q000502:physiology*; D012111:Residence Characteristics; D011795:Surveys and Questionnaires; D013781:Texas; D016138:Walking; D055815:Young Adult