Development Of "Outdoor Moveability Index" For Gated Communities Related To Physical Activity Of Older Adults In Beijing

Purpose:Surveys showed that the proportion of older adults with chronic non-communicable diseases in China were as high as 75%,so healthy aging has become a major component of national strategy.Physical activity(PA)is an important contributor to healthy aging.The community,as one of the main activity places for older adults,provides many activity opportunities for them.Studies have confirmed that the built environment factors affect the PA level of older adults,and the overall built environment index can comprehensively and quantitatively evaluate the built environment’s friendliness to PA.However,only the Walkability Index has been studied in relation to older adults,and most of the index studies have focused on North America and European,and most of them have determined the scope of the study by delineating buffer.So,there is a lack of built environment index that differentiate PA places and evaluate from a microscopic perspective.Therefore,this study aims to development a representative“Outdoor Moveability Index”for gated communities related to PA of older adults in Beijing,to promote the construction of PA-friendly communities for the older adults,and to contribute to healthy aging.Methods:First,based on the literature,summarized the built environment indicators that fit the characteristics of gated communities in Beijing and relate to PA of the older adults.Used the Delphi method to define the indicator structure and design the“Built Environment Perception Questionnaire for the Older adults in Gated Communities in Beijing(initial questionnaire)”.Second,using the establishment time and geographical location of the gated communities as sampling indicators,six types of gated communities in Beijing urban area were selected,and2 communities were selected from each type,making a total of 300 older adults people aged60-80 years old as the study subjects.The study subjects filled out the initial questionnaire,and filled out again 7-14 days later,and the intra-group correlation coefficient(ICC)was used to test the reliability,and questions with ICC≤0.4 were excluded.The remaining questions were tested for structural validity,Amos 24.0 software was used for Confirmatory Factor Analysis(CFA).Then,perform Internal Consistency Evaluation.Among them,the retest reliability randomly selected 20%of the study subjects.The indicators and the structure of the initial questionnaire were adjusted through the reliability test to form the final“Built Environment Perception Questionnaire for the Older adults in Gated Communities in Beijing”,which was used as a collection tool for the built environment indicators in closed communities.Third,the study subjects filled in the“Physical Activity Scale for the Elderly(PASE)”,reported the overall PA time and the PA time in the community.With outdoor PA in the community as the dependent variable,the indicators in the Questionnaire after reliability testing as the independent variables,Pearson and multiple linear regression analyses were conducted,while controlling for demographic factors.The“Outdoor Moveability Index”was constructed by extracting community built environment indicators that have significant correlation with the PA of the older adults and weighting the indicators.Fourth,95 study subjects were selected from those who filled out the questionnaire completely,and their moderate-to-vigorous physical activity(MVPA)in the community were objectively measured using an Acti Graph GT3X+accelerometer,a Holux RCV 3000 GPS instrument.The community environmental data were collected by environmental audits,to calculate the“Outdoor Moveability Index”score.A dichotomous logistic regression analysis was conducted to validate the“Outdoor Moveability Index”,using the Index score as the independent variable and whether the PA met the World Health Organization PA guideline recommendations as the dependent variable.Results:The development of the initial questionnaire with 7 primary indicators such as destination accessibility and 33 secondary indicators such as convenience stores.The retest reliability test results showed that 4 of the 33 questions with ICC≤0.4 were eliminated.The remaining 19 questions were subjected to CFA,and after removing 3 latent variables that did not meet the standardized factor loading coefficient criteria,it showed that the model fit was better(x~2/df=2.005;GFI=0.918;TLI=0.933;IFI=0.952;CFI=0.951;RMSEA=0.065,90%CI:0.051-0.079).The internal consistency reliability of the questionnaire was good(Cronbach’sα=0.835).The final built environment perception indicator system included seven primary indicators and 26 secondary indicators for destination accessibility(10items),walking barriers(3 items),walking infrastructure(3 items),traffic safety(2 items),outdoor activity space availability(3 items),community aesthetics(2 items),and community security(3 items).The results of descriptive statistics showed that the total PASE score was 130.07±44.62,the outdoor PASE score in the community was 26.42±22.93,and the summed mean score of the built environment was 29.88.The results of Pearson correlation analysis showed that destination accessibility(r=0.321,P<0.01),walking infrastructure(r=0.163,P<0.05),and outdoor activity space availability(r=0.261,P<0.01)were positively correlated with outdoor PA in the community.The above three indicators were weighted twice to calculate the total score of“Outdoor Activity Index”,which was included in the multiple linear regression model analysis,and the results showed that there was a significant positive correlation between outdoor PA in the community and the Index score(β=0.991,P<0.01),meanwhile,the explanatory power of the weighted model is optimal for the PA level of the older adults(R~2=0.113,P<0.01).Therefore,the“Outdoor Activity Index”was calculated as follows:score=2×destination accessibility+walking barriers+2×walking infrastructure+traffic safety+2×outdoor activity space availability+community aesthetics+community security.The logistic regression results showed that based on the objective measure of the environmental audit,the odds of meeting the recommended of MVPA was 8.47 times greater for the third quartile group than the referent group(least walkable)with a reported 95%CI of1.75 to 41.13,the odds of meeting the recommended of MVPA was 9.11 times greater for the fourth quartile group than the referent group(least walkable)with a reported 95%CI of 1.87 to44.42.Conclusion:This study developed the“Outdoor Moveability Index”for gated communities related to physical activity of older adults in Beijing,which includes seven indicators of physical activity-related built environment in closed communities.At the same time,it has been preliminarily verified that older adults living in communities with higher“Outdoor Moveability Index”are more likely to achieve the recommended amount of physical activity.