title: The association of the neighbourhood built environment with objectively measured physical activity in older adults with and without lower limb osteoarthritis.
abstract: This study examined the associations of objectively measured neighbourhood built environment characteristics with objectively measured physical activity (PA) in older people with and without lower limb osteoarthritis (LLOA), and assessed whether these relationships differ between both groups.
  
  
  
  Data from the Dutch component of the European Project on OSteoArthritis were used. American College of Rheumatology classification criteria were used to diagnose LLOA (knee and/or hip osteoarthritis). Daily average time spent on total PA and separate PA intensity categories, including light PA, low-light PA, high-light PA, and moderate to vigorous PA, were measured using Actigraph GT3X accelerometers. Geographic Information Systems were used to measure street connectivity (number of street connections per km(2)) and distances (in km) to resources (health care resources, retail resources, meeting places, and public transport) within neighbourhoods. Multiple Linear Regression Analyses were used to examine the associations between measures of the neighbourhood built environment and PA, adjusted for several confounders.
  
  
  
  Of all 247 participants (66-85 years), 41 (16.6 %) had LLOA. The time spent on any PA did not differ significantly between participants with and without LLOA (LLOA: Mean = 268.3, SD = 83.3 versus non-LLOA: Mean = 275.8, SD = 81.2; p = 0.59). In the full sample, no measures of the neighbourhood built environment were statistically significantly associated with total PA. Larger distances to specific health care resources (general practice and physiotherapist) and retail resources (supermarket) were associated with more time spent on PA in older people with LLOA than in those without LLOA. In particular, the associations of light and high-light PA with distances to these specific resources were stronger in participants with LLOA compared to their counterparts without LLOA.
  
  
  
  Specific attributes of the neighbourhood built environment are more strongly associated with PA in older people with LLOA than in those without LLOA. Knowledge on the relationship between objectively measured neighbourhood characteristics and PA in older people with and without LLOA could be used to inform policymakers and city planners about adaptation of neighbourhoods and their infrastructures to appropriately facilitate PA in healthy and functionally impaired older adults.
authors.affiliation: Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Centre, De Boelelaan 1089A, 1081HV, Amsterdam, The Netherlands. ej.timmermans@vumc.nl.
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Timmermans
authors.affiliation: Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, 1081HV, Amsterdam, The Netherlands.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Schaap
authors.affiliation: Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, 1081HV, Amsterdam, The Netherlands.|Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Centre, De Boelelaan 1117, 1081BT, Amsterdam, The Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Visser
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
authors.forename: Hidde P
authors.initials: HP
authors.lastname: van der Ploeg
authors.affiliation: Department of Environmental Economics, Institute for Environmental Studies, VU University Amsterdam, De Boelelaan 1085, 1081HV, Amsterdam, The Netherlands.
authors.forename: Alfred J
authors.initials: AJ
authors.lastname: Wagtendonk
authors.affiliation: Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Centre, De Boelelaan 1089A, 1081HV, Amsterdam, The Netherlands.
authors.forename: Suzan
authors.initials: S
authors.lastname: van der Pas
authors.affiliation: Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Centre, De Boelelaan 1089A, 1081HV, Amsterdam, The Netherlands.
authors.forename: Dorly J H
authors.initials: DJ
authors.lastname: Deeg
mesh_terms: D061725:Accelerometry; D000368:Aged; D000369:Aged, 80 and over; D002947:Cities; D004779:Environment Design; D015444:Exercise; D005260:Female; D040362:Geographic Information Systems; D006295:Health Resources; D006296:Health Services; D006304:Health Status; D006801:Humans; D035002:Lower Extremity; D008297:Male; D009426:Netherlands; D015207:Osteoarthritis, Hip; D020370:Osteoarthritis, Knee; D012016:Reference Values; D012111:Residence Characteristics; D062206:Spatial Analysis
keywords: Accelerometry; Geographic Information Systems; Neighbourhood built environment; Older population; Osteoarthritis; Physical activity