Literature review: health promoting community design: concepts guiding the study of the impact of the built environment on physical activity for older adults: a review of the literature

Objective. To identify theoretical models and key concepts used to predict the association between built environment and seniors' physical activity on the basis of a comprehensive review of the published literature. Data Source. Computer searches of Medline (1966-2002), PubMed (1966-2002), and Academic Search Elite (1966-2002) were conducted, and 27 English-language articles were found. Search terms included built environment, physical activity, exercise, walking, neighborhood, urban design, seniors, aging, aging in place, and physical environment. Study Inclusion and Exclusion Criteria. The primary inclusion criterion included the relation between the built environment and the physical activity among seniors living in neighborhoods. Studies assessing physical activity or overall health of a community-based population were included if underlying theoretical models and concepts were applicable to a senior population. Studies solely assessing social or psychosocial characteristics of place were excluded, as were review articles. Data Extraction. Extracted data included theoretical model, aspect of built environment studied, methods, and outcomes. Data Synthesis. Tables present key definitions and summarize information from empirical studies. Results. Twenty-seven articles that focused on the environment-behavior relation in neighborhoods, six specific to seniors, were found. This area of research is in its infancy, and inconsistent findings reflect difficulties in measurement of the built environment. Conclusions. The relation between the built environment and the physical activity among seniors has been the subject of a limited number of studies. The choice of theoretical model drives the selection of concepts and variables considered. Safety, microscale urban design elements, aesthetics, and convenience of facilities are consistently studied across models. Few validated instruments have been developed and tested to measure neighborhood built environment. (Original abstract)