Neighbourhood walkability and home neighbourhood-based physical activity: an observational study of adults with type 2 diabetes.
Converging international evidence suggests that diabetes incidence is lower among adults living in more walkable neighbourhoods. The association between walkability and physical activity (PA), the presumed mediator of this relationship, has not been carefully examined in adults with type 2 diabetes. We investigated the associations of walkability with total PA occurring within home neighbourhoods and overall PA, irrespective of location.



Participants (n = 97; 59.5 ± 10.5 years) were recruited through clinics in Montreal (QC, Canada) and wore a GPS-accelerometer device for 7 days. Total PA was expressed as the total Vector of the Dynamic Body Acceleration. PA location was determined using a Global Positioning System (GPS) device (SIRF IV chip). Walkability (street connectivity, land use mix, population density) was assessed using Geographical Information Systems software. The cross-sectional associations between walkability and location-based PA were estimated using robust linear regressions adjusted for age, body mass index, sex, university education, season, car access, residential self-selection, and wear-time.



A one standard deviation (SD) increment in walkability was associated with 10.4 % of a SD increment in neighbourhood-based PA (95 % confidence interval (CI) 1.2, 19.7) - equivalent to 165 more steps/day (95 % 19, 312). Car access emerged as an important predictor of neighbourhood-based PA (Not having car access: 38.6 % of a SD increment in neighbourhood-based PA, 95 % CI 17.9, 59.3). Neither walkability nor car access were conclusively associated with overall PA.



Higher neighbourhood walkability is associated with higher home neighbourhood-based PA but not with higher overall PA. Other factors will need to be leveraged to facilitate meaningful increases in overall PA among adults with type 2 diabetes.
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC, Canada.
Samantha
S
Hajna
Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CHUM), Tour St-Antoine, S02-340, 850 St-Denis, Montreal, QC, Canada.
Yan
Y
Kestens
Department of Medicine, Division of Internal Medicine, McGill University Health Centre, Montreal General Hospital, 1650 Cedar Avenue, C2.101.4, Montréal, QC, Canada.
Stella S
SS
Daskalopoulou
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC, Canada.|Department of Medicine, Division of Clinical Epidemiology, McGill University Health Centre, 687 Pine Avenue West, V1.08, Montréal, QC, Canada.
Lawrence
L
Joseph
Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CHUM), Tour St-Antoine, S02-340, 850 St-Denis, Montreal, QC, Canada.
Benoit
B
Thierry
Department of Medicine, Division of Endocrinology, McGill University Health Centre, 1001 Boulevard Decarie, Montreal, QC, Canada.
Mark
M
Sherman
Division of Internal Medicine, Jewish General Hospital, 3755 Cote Sainte-Catherine, Montreal, QC, Canada.
Luc
L
Trudeau
Institut de Recherches Cliniques de Montréal (IRCM), 110 avenue des Pins, Montréal, QC, Canada.
Rémi
R
Rabasa-Lhoret
Department of Medicine, Division of Endocrinology, St. Mary's Hospital, 3830 Lacombe Avenue, Montreal, QC, Canada.
Leslie
L
Meissner
Montreal Behavioural Medicine Centre, Hôpital du Sacré-Cœur de Montréal, 5400 Boul. Gouin Ouest, Montréal, QC, Canada.|Department of Exercise Science, Concordia University, 7141 Sherbrooke Street West, Montreal, QC, Canada.
Simon L
SL
Bacon
Département de médecine sociale et préventive, École de Santé Publique, Université de Montréal, 7101 avenue du Parc, Montréal, QC, Canada.
Lise
L
Gauvin
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC, Canada.|Department of Geography, McGill University, 805 Sherbrooke Street West, Montreal, QC, Canada.
Nancy A
NA
Ross
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC, Canada. kaberi.dasgupta@mcgill.ca.|Department of Medicine, Division of Clinical Epidemiology, McGill University Health Centre, 687 Pine Avenue West, V1.08, Montréal, QC, Canada. kaberi.dasgupta@mcgill.ca.
Kaberi
K
Dasgupta
D000328:Adult; D000368:Aged; D002170:Canada; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2; D004779:Environment Design / Q000706:statistics & numerical data*; D015444:Exercise; D005260:Female; D040362:Geographic Information Systems; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D016138:Walking
Accelerometry; Environmental epidemiology; Global Positioning Systems; Health geography; Neighbourhood walkability; Physical activity; Physical activity locations; Type 2 diabetes