title: Neighborhood walkability, fear and risk of falling and response to walking promotion: The Easy Steps to Health 12-month randomized controlled trial.
abstract: In older adults the relationships between health, fall-related risk factors, perceived neighborhood walkability, walking behavior and intervention impacts are poorly understood. To determine whether: i) health and fall-related risk factors were associated with perceptions of neighborhood walkability; ii) perceived environmental attributes, and fall-related risk factors predicted change in walking behavior at 12 months; and iii) perceived environmental attributes and fall-related risk factors moderated the effect of a self-paced walking program on walking behavior. Randomized trial on walking and falls conducted between 2009 and 2012 involving 315 community-dwelling inactive adults ≥ 65 years living in Sydney, Australia. Measures were: mobility status, fall history, injurious fall and fear of falling (i.e., fall-related risk factors), health status, walking self-efficacy and 11 items from the neighborhood walkability scale and planned walking ≥ 150 min/week at 12 months. Participants with poorer mobility, fear of falling, and poor health perceived their surroundings as less walkable. Walking at 12 months was significantly greater in "less greenery" (AOR = 3.3, 95% CI: 1.11-9.98) and "high traffic" (AOR = 1.98, 95% CI: 1.00-3.91) neighborhoods. The intervention had greater effects in neighborhoods perceived to have poorer pedestrian infrastructure (p for interaction = 0.036). Low perceived walkability was shaped by health status and did not appear to be a barrier to walking behavior. There appears to be a greater impact of, and thus, need for, interventions to encourage walking in environments perceived not to have supportive walking infrastructure. Future studies on built environments and walking should gather information on fall-related risk factors to better understand how these characteristics interact.
authors: School of Science and Health, University of Western Sydney, Locked Bag 1797, Penrith NSW 2751, Australia.
authors: D
authors: D
authors: Merom
authors: Centre for Chronic Disease Prevention, College of Public Health, Medical & Veterinary Sciences, James Cook University, PO Box 6811, Cairns, QLD 4870, Australia.
authors: K
authors: K
authors: Gebel
authors: School of Science and Health, University of Western Sydney, Locked Bag 1797, Penrith NSW 2751, Australia.
authors: P
authors: P
authors: Fahey
authors: School of Science and Health, University of Western Sydney, Locked Bag 1797, Penrith NSW 2751, Australia.
authors: T
authors: T
authors: Astell-Burt
authors: Health Promotion Service, Sydney and South West Sydney Local Health District, Sydney, Camperdown, NSW 2050, Australia; School of Public Health and Community Medicine, University of NSW, Sydney, Australia.
authors: A
authors: A
authors: Voukelatos
authors: School of Public Health, Level 6, Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia.
authors: C
authors: C
authors: Rissel
authors: The George Institute for Global Health, Sydney Medical School, University of Sydney, Level 13, 321, Kent St Sydney, NSW 2000, Australia.
authors: C
authors: C
authors: Sherrington
keywords: Fall; Neighborhood; Older adults; Randomized controlled trial; Walkability; Walking