5.2.1 Walking difficulty as a contextual factor (Study II)
Similarities and differences in the associations of objectively assessed features of the natural environment with self-reported PA and with perceiving nature as a facilitator of outdoor mobility were investigated with respect to self-reported difficulty in walking 500 m in Study II. Among the participants without difficulty in walking 500 m, only higher habitat diversity in a large natural area within a distance of 1 000 m from home showed higher likelihood for reporting more than three hours a week of at least moderate PA compared to reporting less than three hours a week of only light PA (Table 8). Among the participants with walking difficulty, having a waterside area and higher number of land types within a radius of 500 m from their home showed higher odds for higher PA whereas higher habitat diversity in large natural areas within distances of 500 m and 1 000 m from home showed lower odds for being more active physically.
In the associations between objectively assessed features of the natural environment and perceiving nature as a facilitator of outdoor mobility, having a waterside area and a higher number of land types within 500 m from home increased the odds for perceiving nature as a facilitator for both those without and those with walking difficulty. In addition, for those without difficulty in walking 500 m, higher habitat diversity in a large natural area within 500 m from home, higher diversity in land use within distances of 500 m and 1000 m and a higher number of land types within 1 000 m from home increased the odds for perceiving nature as a facilitator for outdoor mobility. Perceiving nature as a facilitator of outdoor mobility increased the odds for reporting at least moderate PA among those with difficulty in walking only.
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TABLE 8 Associations of objectively assessed features of the natural environment with reporting at least moderate physical activity (PA) (vs. only light PA) and with perceiving (vs. not perceiving) nature as a facilitator for outdoor mobil-ity (n=848)
Reporting at least moderate PA
(vs. only light PA) Perceiving nature as a facilitator for outdoor mobility (vs. not perceiving)
Without walking
difficulty (n=631) With walking
diffi-culty (n=217) Without walking
difficulty (n=631) With walking dif-ficulty (n=217) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) Objectively assessed features of the natural environment within a 500-m radius of home Presence of water (reference class: no)
yes 0.97 (0.59-1.59) 4.01 (1.26-12.80) 2.57 (1.66-3.98) 2.57 (1.25-5.28) Patch density (reference class: low)
middle 0.76 (0.46-1.26) 0.60 (0.24-1.47) 1.51 (0.95-2.41) 0.82 (0.40-1.72) high 0.77 (0.46-1.29) 0.61 (0.27-1.36) 1.22 (0.76-1.96) 0.97 (0.49-1.91) Land types (reference class: low)
middle 1.00 (0.61-1.64) 2.68 (1.08-6.65) 1.37 (0.87-2.16) 1.81 (0.90-3.64) high 1.42 (0.85-2.36) 1.56 (0.57-4.29) 3.34 (1.99-5.60) 2.15 (1.01-4.60) Diversity of land use (reference class: low)
middle 0.80 (0.48-1.33) 0.87 (0.38-1.96) 1.44 (0.93-2.24) 1.44 (0.73-2.88) high 0.75 (0.46-1.24) 0.72 (0.30-1.74) 3.35 (2.01-5.60) 1.99 (0.96-4.11) Habitat diversity within large natural area (reference class: low)
middle 0.83 (0.50-1.38) 0.30 (0.11-0.84) 1.40 (0.86-2.27) 0.72 (0.34-1.55) high 1.40 (0.84-2.34) 0.63 (0.27-1.46) 1.82 (1.11-2.96) 1.61 (0.78-3.30) Objectively assessed features of the natural environment within a 1 000-m radius of home Patch density (reference class: low)
middle 1.24 (0.75-2.07) 0.69 (0.29-1.66) 0.63 (0.39-1.02) 0.64 (0.31-1.31) high 0.95 (0.57-1.58) 0.78 (0.34-1.79) 0.73 (0.44-1.21) 0.67 (0.33-1.38) Land types (reference class: low)
middle 1.43 (0.87-2.37) 1.09 (0.45-2.63) 1.24 (0.78-1.95) 1.53 (0.74-3.13) high 1.45 (0.83-2.53) 0.73 (0.26-2.03) 3.13 (1.76-5.55) 1.50 (0.67-3.37) Diversity of land use (reference class: low)
middle 0.92 (0.56-1.50) 0.90 (0.38-2.12) 1.15 (0.74-1.79) 0.65 (0.32-1.32) high 1.05 (0.64-1.73) 1.04 (0.44-2.47) 2.53 (1.53-4.20) 1.08 (0.52-2.28) Habitat diversity within large natural area (reference class: low)
middle 1.02 (0.63-1.65) 0.31 (0.12-0.82) 1.18 (0.74-1.89) 0.67 (0.33-1.37) high 1.82 (1.08-3.04) 1.08 (0.47-2.44) 1.20 (0.75-1.92) 1.60 (0.76-3.35) Perceived environmental facilitator of outdoor mobility
Perceiving nature as a facilitator for outdoor mobility (reference class: no) yes 1.34 (0.85-2.11) 3.05 (1.35-6.86)
Odds ratio (OR) and their 95% confidence intervals (CI) for univariate logistic regression models adjusted for age, sex, number of chronic conditions, years of education, time at cur-rent address, type of residential area. Values in bold; p < 0.05.
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5.2.2 Neighbourhood type as a contextual factor (Study III)
Perceiving environmental facilitators of outdoor mobility in different types of neighbourhoods and the associations between perceived facilitators and self-reported PA were investigated in Study III. The sample was stratified into neighbourhood types, i.e., city centre, subcentre, dense areas outside centres, and dispersed areas outside centres. In all neighbourhood types, at least half of the participants perceived nature and lakeside areas and walking and skiing trails as facilitators for outdoor mobility (Table 9). In neighbourhoods with a centre and areas with higher population density, the proportion of participants reporting infrastructure-based facilitators was higher than in neighbourhoods in dispersed areas outside centres.
The association of each perceived outdoor mobility facilitator with self-reported PA was analysed with logistic regression for each neighbourhood type separately. In the city centre and in densely populated areas outside centres, two of the three nature-based destinations, that is nature and lakeside areas and walking and skiing trails, increased the odds for reporting at least moderate PA vs. only light PA (Table 9). In these neighbourhood types a lower proportion of infrastructure-based facilitators, compared to nature-based facilitators, were associated with reporting higher PA, these being walkways without steep hills and good lighting in city centres and safe crossings in dense areas outside centres.
In dispersed areas outside centres, perceiving parks or other green areas as an outdoor mobility facilitator was the only nature-based destination positively associated with reporting at least moderate PA, whereas several infrastructure-based facilitators, i.e., peaceful walkways, good lighting, and even sidewalks, were associated with higher PA. Among participants living in subcentres, none of the perceived facilitators for outdoor mobility was associated with reporting higher PA.
TABLE 9 Reports of perceived facilitators for outdoor mobility in different neighbourhood types, and likelihood for self-reporting higher phys-ical activity (PA) compared to only light PA when perceiving the facilitator (vs. not perceiving the facilitator) (n=848)
City centre (n=229) Subcentre (n=144) Dense areas outside
centres (n=237) Dispersed areas outside centres (n=238)
% OR (95% CI) % OR (95% CI) % OR (95% CI) % OR (95% CI) p-value Perceived nature-based destinations as facilitators (reference class: not perceived)
Nature, lakeside 64 2.58 (1.26-5.28) 76 0.68 (0.22-2.06) 78 2.33 (1.08-5.03) 74 1.48 (0.70-3.16) 0.006 Walking/skiing trail 55 4.38 (2.15-8.93) 60 1.07 (0.43-2.65) 65 3.07 (1.53-6.15) 50 1.65 (0.84-3.22) 0.009 Park or other green area 57 1.96 (0.97-3.96) 42 0.92 (0.38-2.21) 40 1.77 (0.87-3.60) 25 2.41 (1.03-5.59) <0.001 Perceived infrastructure-based facilitators (reference class: not perceived)
Peaceful walkways 52 1.35 (0.68-2.66) 58 1.25 (0.53-3.00) 57 1.06 (0.54-2.08) 37 2.60 (1.26-5.33) <0.001 Services close 65 1.46 (0.72-2.96) 57 1.73 (0.71-4.24) 36 0.98 (0.48-1.98) 23 0.52 (0.24-1.15) <0.001 Good lighting 42 2.19 (1.07-4.49) 40 0.70 (0.28-1.75) 44 0.99 (0.49-1.98) 25 2.46 (1.08-5.59) <0.001 Even sidewalks 38 1.98 (0.95-4.12) 31 0.82 (0.33-2.09) 33 1.10 (0.54-2.25) 18 2.75 (1.08-7.01) <0.001 Safe crossings 28 2.23 (0.98-5.06) 25 1.01 (0.38-2.70) 32 2.52 (1.14-5.58) 12 3.19 (0.91-11.09) <0.001 Resting places along walkways 31 1.21 (0.59-2.50) 25 1.93 (0.67-5.52) 18 1.73 (0.70-4.30) 9 2.38 (0.66-8.61) <0.001 Walkways without steep hills 19 2.63 (1.03-6.74) 18 0.58 (0.19-1.80) 12 3.40 (0.96-12.09) 5 1.78 (0.40-7.86) <0.001 Analyses were conducted separately for each facilitator in each neighbourhood type. Odds ratio (OR) and their 95% confidence intervals (CI) for univariate logistic regression models adjusted for age, sex, difficulty in walking 500 m, chronic conditions, education, and years in current home. p-values from Pearson’s Chi-square test for differences in reports of perceived facilitators across different neighbourhood types. Values in bold; p <
0.05.
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5.2.3 Day of the week as a contextual factor (Study IV)
In Study IV, the associations between objectively assessed features of the environment and accelerometer-measured PA with respect to the day of the week were analysed using linear regression. As can be seen from the Bland-Altman plots (Figure 6a and 6a), the accelerometer-measured PA levels showed some differences between weekdays and weekend days for individuals with different average PA volumes. On average, individuals accumulated 0.06 more PA bouts [t(166) = 1.015, p = 0.311] and 1.64 fewer MVPA minutes [t(166) = −0.972, p = 0.332] on weekend days than weekdays, but these differences were not statistically significant. However, participants with lower volumes of PA in general tended to show an even lower PA level on weekend days than on weekdays. The number of participants with zero PA bouts was higher on weekend days (72 participants) than on weekdays (43 participants) [χ2(1)=48.366, p < 0.001].
a) b)
FIGURE 6 Bland-Altman plots for accelerometer-measured a) number of PA bouts on weekend days vs. weekdays; and b) MVPA minutes on weekend days vs.
weekdays. Mean difference with 95% confidence intervals and regression line (n=167). PA = Physical activity; MVPA = Moderate to vigorous physical activity. (Modified from Study IV.)
Associations between objectively assessed features of the environment and accelerometer-measured PA with respect to the day of the week are shown in Table 10. On weekdays, habitat diversity in large natural and green areas, intersection density, and residential density were positively associated with the number of PA bouts and MVPA minutes. On weekends, only habitat diversity showed a positive association with MVPA minutes. Road network slope was negatively associated with PA bouts throughout the week and with MVPA on weekend days. Number of land types showed no association with PA.
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TABLE 10 Associations of objectively assessed features of environment with number of PA bouts and MVPA minutes on weekdays and weekend days (n=167)
Weekdays Weekend days
Number of PA PA = Physical activity; MVPA = Moderate to vigorous physical activity; SHDI = Shannon's Diversity Index.
Antilogarithm values of unstandardized regression coefficients (expβ) and their 95% confi-dence intervals (CI) from univariate linear regression models adjusted for age, sex, accel-erometer wear time, and difficulty in walking 500 m. The expβ value shows the effect of a one-unit increase in the predictor value on the outcome variable value, e.g., a one-unit in-crease in residential density, equalling an inin-crease of 1 000 residents in a 1-km2 area, shows a 9% increase in the number of PA bouts and 15% increase in MVPA minutes on weekdays but no statistically significant change in PA on weekend days. Values in bold; p < 0.05.
5.3 Estimated influence of walking difficulty vs. objectively