環境因素與高齡者步行行為之系統性文獻回顧

A systematic review of environmental factors and older adults' walking behavior

10.3966/102472972018125104001

廖邕(Yung Liao)；林倩宇(Chien-Yu Lin)；朴勝泰(Hyuntae Park)；岡浩一朗(Koichiro Oka)

建成環境 ； 自覺環境 ； 身體活動 ； 老化 ； built environment ； perceived environment ； physical activity ； aging

體育學報

51卷4期（2018 / 12 / 01）

411 - 424

繁體中文

緒論：身體活動量不足是高齡者健康的行為危險因子。「步行」是最適合高齡者身體活動的形式之一，而「環境」又為影響高齡者從事步行行為之重要決定因子。本文將以生態學架構為基礎，進一步探討影響高齡者步行的重要環境因素，包括客觀的「建成環境因素」與主觀的「自覺環境因素」。方法：本研究欲透過系統性文獻回顧，歸結有關客觀建成環境、主觀自覺環境因素與高齡者主、客觀步行行為的未來研究方向與建議。結果：符合納入條件的19篇研究中，18篇文章為量性研究，且均為橫斷性設計、另1篇為質性研究。此外，多數研究使用問卷測量步行行為，只有少數採用客觀儀器測量。整體而言，納入研究中的環境因素變項以主客觀的「環境宜走性(walkability)」為核心概念，研究結果顯示：密度、土地使用多樣性、安全、友善環境等面向與高齡者的不同步行行為類型呈正向關聯性。結論：未來仍需要更多的縱貫性世代追蹤或準實驗研究設計來進一步了解環境與高齡者步行之因果關係。其次，自我選擇(self-selection)因素需納入控制變項，以釐清環境與高齡者步行行為的關聯性。第三、步行行為測量工具，宜兼採主觀與客觀測量以提升準確性。第四，各研究對於高齡者的居家緩衝區(buffer zone)並不一致，難以界定高齡者近鄰環境之範圍。第五，考量到環境因素測量的限制，Walk score®網站為新興客觀宜走性測量工具，然而，其於亞洲國家之效度仍需檢驗。最後，有鑑於亞洲國家在文化、人口密度及環境建構與西方國家的差異，需進一步提出適合亞洲國家的宜走性指標。

Introduction: Physical inactivity is a behavioral risk factor of elderly's health. Walking behavior has been recognized as a suggested form of physical activity for older adults. Evidence shows that environment is a determinants of older adults' walking behavior. According to Ecological model, this study aims to review the literature between environment and older adults' walking, including objectively-measured built environment and perceived environment. Methods: This study using systematic review to better understand the associations of objectively-measured and subjectively environmental factors with older adults' objective and subjective walking behavior, in order to provide future suggestions. Results: Among 19 included studies, 17 were quantitative studies using cross-sectional design. Overall, included studies used walkability as core concept of environmental factors. The results showed that density, safety, land use mix and friendly environment is positively associated with different types of walking behavior among older adults. Besides, more studies using questionnaire to assess older adults' walking behavior, fewer studies have used objective measures. Conclusion: First, more qualitative studies are still needed to better understand the perceived barriers and facilitators of walking behavior among older adults. In addition, self-selection should be included as a key confounder to clarify the influence of environment on walking behavior. Moreover, prospective or quasi experimental design not only can minimize the self-selection bias (active individuals tend to choose neighborhoods conductive to physical activity), as well as improving evidence related to causality. Third, studies can be beneficial to utilize both objective and subjective measures of walking behavior for accuracy. Fourth, the definition of buffer zone varied in different studies and thus it is difficult to define the neighborhood environment of older adults. Fifth, for considering the limitation of environmental measures, Walk score^® website is a novel tool for measuring walkability. However, the validity of Walk score^® website should be further tested in Asian countries. Finally, considering the different culture, residential density and infrastructure between Asian and Western Countries, it is important to further provide the indicators of Walkability for Asian countries.

1. Barnett, A.,Cerin, E.,Zhang, C. J. P.,Sit, C. H. P.,Johnston, J. M.,Cheung, M. M. C.,Lee, R. S. Y.(2016).Associations between the neighbourhood environment characteristics and physical activity in older adults with specific types of chronic conditions: The ALECS cross-sectional study.International Journal of Behavioral Nutrition and Physical Activity,13,53.
2. Barnett, D. W.,Barnett, A.,Nathan, A.,Van Cauwenberg, J.,Cerin, E.(2017).Built environmental correlates of older adults' total physical activity and walking: A systematic review and meta-analysis.International Journal of Behavioral Nutrition and Physical Activity,14(1),103.
3. Carr, L. J.,Dunsiger, S. I.,Marcus, B. H.(2010).Walk score as a global estimate of neighborhood walkability.American Journal of Preventive Medicine,39(5),460-463.
4. Caspersen, C. J.,Powell, K. E.,Christenson, G. M.(1985).Physical activity, exercise, and physical fitness: Definitions and distinctions for health-related research.Public Health Reports,100(2),126-131.
5. Cerin, E.,Sit, C. H.,Zhang, C. J.,Barnett, A.,Cheung, M. M.,Lai, P. C.,Lee, R. S.(2016).Neighbourhood environment, physical activity, quality of life and depressive symptoms in Hong Kong older adults: A protocol for an observational study.BMJ Open,6(1),e010384.
6. Chudyk, A. M.,McKay, H. A.,Winters, M.,Sims-Gould, J.,Ashe, M. C.(2017).Neighborhood walkability, physical activity, and walking for transportation: A cross-sectional study of older adults living on low income.BMC Geriatrics,17(1),82.
7. Chudyk, A. M.,Winters, M.,Moniruzzaman, M.,Ashe, M. C.,Gould, J. S.,McKay, H.(2015).Destinations matter: The association between where older adults live and their travel behavior.Journal of Transport & Health,2(1),50-57.
8. Corseuil Giehl, M. W.,Hallal, P. C.,Brownson, R. C.,d'Orsi, E.(2017).Exploring associations between perceived measures of the environment and walking among brazilian older adults.Journal of Aging and Health,29(1),45-67.
9. Ding, D.,Lawson, K. D.,Kolbe-Alexander, T. L.,Finkelstein, E. A.,Katzmarzyk, P. T.,van Mechelen, W.,Pratt, M.(2016).The economic burden of physical inactivity: A global analysis of major non-communicable diseases.The Lancet,388(10051),1311-1324.
10. Gomez, L. F.,Parra, D. C.,Buchner, D.,Brownson, R. C.,Sarmiento, O. L.,Pinzon, J. D.,Lobelo, F.(2010).Built environment attributes and walking patterns among the elderly population in Bogota.American Journal of Preventive Medicine,38(6),592-599.
11. Hallal, P. C.,Gomez, L. F.,Parra, D. C.,Lobelo, F.,Mosquera, J.,Florindo, A. A.,Sarmiento, O. L.(2010).Lessons learned after 10 years of IPAQ use in Brazil and Colombia.Journal of Physical Activity and Health,7(Suppl 2),S259-264.
12. Hsueh, M. C.,Liao, Y.,Chang, S. H.(2016).Perceived neighborhood and home environmental factors associated with television viewing among taiwanese older adults.International Journal of Environmental Research and Public Health,13(7),708.
13. Humpel, N.,Owen, N.,Iverson, D.,Leslie, E.,Bauman, A.(2004).Perceived environment attributes, residential location, and walking for particular purposes.American Journal of Preventive Medicine,26(2),119-125.
14. Lee, I. M.,Buchner, D. M.(2008).The importance of walking to public health.Medicine and Science in Sports and Exercise,40(7 Suppl),S512-518.
15. Maisel, J. L.(2016).Impact of older adults' neighborhood perceptions on walking behavior.Medicine and Science in Sports and Exercise,24(2),247-255.
16. Marquet, O.,Hipp, J. A.,Miralles-Guasch, C.(2017).Neighborhood walkability and active ageing: A difference in differences assessment of active transportation over ten years.Journal of Transport & Health,7,190-201.
17. Merom, D.,Chey, T.,Chau, J.,Smith, B. J.,Barr, M.,Bauman, A. E.(2009).Are messages about lifestyle walking being heard? Trends in walking for all purposes in New South Wales (NSW), Australia.Preventive Medicine,48(4),341-344.
18. Mitra, R.,Siva, H.,Kehler, M.(2015).Walk-friendly suburbs for older adults? Exploring the enablers and barriers to walking in a large suburban municipality in Canada.Journal of Aging Studies,35,10-19.
19. Morris, J. N.,Hardman, A. E.(1997).Walking to health.Sports Medicine,23(5),306-332.
20. Murtagh, E. M.,Murphy, M. H.,Boone-Heinonen, J.(2010).Walking: The first steps in cardiovascular disease prevention.Current Opinion in Cardiology,25(5),490-496.
21. Ory, M. G.,Towne, S. D., Jr.,Won, J.,Forjuoh, S. N.,Lee, C.(2016).Social and environmental predictors of walking among older adults.BMC Geriatrics,16,155.
22. Pate, R. R.,Pratt, M.,Blair, S. N.,Haskell, W. L.,Macera, C. A.,Bouchard, C.,Wilmore, J. H.(1995).Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine.The Journal of the American Medical Association,273(5),402-407.
23. Paterson, D. H.,Warburton, D. E.(2010).Physical activity and functional limitations in older adults: A systematic review related to Canada's physical activity guidelines.International Journal of Behavioral Nutrition and Physical Activity,7(1),38.
24. PRISMA. (2015). Transparent reporting of systematic reviews and meta-analyses. Retrieved from http://prisma-statement.org/Accessed 11, Jul 2018.
25. Reis, R. S.,Salvo, D.,Ogilvie, D.,Lambert, E. V.,Goenka, S.,Brownson, R. C.,Committee, L. P. A. S. E.(2016).Scaling up physical activity interventions worldwide: Stepping up to larger and smarter approaches to get people moving.The Lancet,388(10051),1337-1348.
26. Rzewnicki, R.,Vanden Auweele, Y.,De Bourdeaudhuij, I.(2003).Addressing overreporting on the international physical activity questionnaire (IPAQ) telephone survey with a population sample.Public Health Nutrition,6(3),299-305.
27. Sakari, R.,Rantakokko, M.,Portegijs, E.,Iwarsson, S.,Sipila, S.,Viljanen, A.,Rantanen, T.(2017).Do associations between perceived environmental and individual characteristics and walking limitations depend on lower extremity performance level?.Public Health Nutrition,29(4),640-656.
28. Sallis, J. F.,Owen, N.(2008).Ecological models of health behavior. In Health Behavior and Health Education.San Francisco:Jossey-Bass.
29. Sun, F.,Norman, I. J.,While, A. E.(2013).Physical activity in older people: A systematic review.BMC Public Health,13,449.
30. Thornton, C. M.,Kerr, J.,Conway, T. L.,Saelens, B. E.,Sallis, J. F.,Ahn, D. K.,King, A. C.(2017).Physical activity in older adults: an ecological approach.Annals of Behavioral Medicine,51(2),159-169.
31. Todd, M.,Adams, M. A.,Kurka, J.,Conway, T. L.,Cain, K. L.,Buman, M. P.,King, A. C.(2016).GIS-measured walkability, transit, and recreation environments in relation to older adults' physical activity: A latent profile analysis.Preventive Medicine,93,57-63.
32. Troped, P. J.,Tamura, K.,McDonough, M. H.,Starnes, H. A.,James, P.,Ben-Joseph, E.,Laden, F.(2017).Direct and indirect associations between the built environment and leisure and utilitarian walking in older women.Annals of Behavioral Medicine,51(2),282-291.
33. Tudor-Locke, C.,Craig, C. L.,Aoyagi, Y.,Bell, R. C.,Croteau, K. A.,De Bourdeaudhuij, I.,Blair, S. N.(2011).How many steps/day are enough? For older adults and special populations.International Journal of Behavioral Nutrition and Physical Activity,8(1),80.
34. Van Cauwenberg, J.,De Bourdeaudhuij, I.,Clarys, P.,Nasar, J.,Salmon, J.,Goubert, L.,Deforche, B.(2016).Street characteristics preferred for transportation walking among older adults: a choice-based conjoint analysis with manipulated photographs.International Journal of Behavioral Nutrition and Physical Activity,13,6.
35. Van Holle, V.,Van Cauwenberg, J.,De Bourdeaudhuij, I.,Deforche, B.,Van de Weghe, N.,Van Dyck, D.(2016).Interactions between neighborhood social environment and walkability to explain Belgian older adults' physical activity and sedentary time.International Journal of Environmental Research and Public Health,13(6),569.
36. Van Holle, V.,Van Cauwenberg, J.,Deforche, B.,Van de Weghe, N.,De Bourdeaudhuij, I.,Van Dyck, D.(2015).Do psychosocial factors moderate the association between objective neighborhood walkability and older adults' physical activity?.Health & Place,34,118-125.
37. Wagner, A.,Simon, C.,Ducimetiere, P.,Montaye, M.,Bongard, V.,Yarnell, J.,Arveiler, D.(2001).Leisure-time physical activity and regular walking or cycling to work are associated with adiposity and 5 y weight gain in middle-aged men: The PRIME Study.International Journal of Obesity and Related Metabolic Disorders,25(7),940-948.
38. Weber Corseiul Giehl, M.,Hallal, P. C.,Weber Corseuil, C.,Schneider, I. J.,d'Orsi, E.(2016).Built environment and walking behavior among Brazilian older adults: A population-based study.Journal of Physical Activity & Health,13(6),617-624.
39. Winters, M.,Barnes, R.,Venners, S.,Ste-Marie, N.,McKay, H.,Sims-Gould, J.,Ashe, M. C.(2015).Older adults' outdoor walking and the built environment: does income matter?.BMC Public Health,15(1),876.
40. World Health Organization(2010).Global recommendations on physical activity for health.
41. World Health Organization(2012).Global recommendations on physical activity for health.
42. World Health Organization(2002).Active ageing: a policy framework.
43. Zandieh, R.,Flacke, J.,Martinez, J.,Jones, P.,van Maarseveen, M.(2017).Do inequalities in neighborhood walkability drive disparities in older adults' outdoor walking?.International Journal of Environmental Research and Public Health,14(7),740.
44. Zandieh, R.,Martinez, J.,Flacke, J.,Jones, P.,van Maarseveen, M.(2016).Older adults' outdoor walking: Inequalities in neighbourhood safety, pedestrian infrastructure and aesthetics.International Journal of Environmental Research and Public Health,13(12),1179.
45. Zhai, Y.,Baran, P. K.(2017).Urban park pathway design characteristics and senior walking behavior.Urban Forestry & Urban Greening,21,60-73.
46. 行政院衛生福利部國民健康署(2010)。臺灣健康體能指引。臺北市=Taipei City:作者=Author。
47. 賴南廷(2007)。嘉義縣=Chia-Yi County，國立中正大學=National Chung Cheng University。

1. 程瑞福,林恩賜,方怡堯(2022)。生態學模式應用於社區高齡者運動方案之介入效益。中華體育季刊，36(3)，233-242。
2. 劉宗翰,陳韋翰,相子元,林羿志,李尹鑫(2020)。下肢肢段參數與自主轉換速度的相關分析。體育學報，53(4)，429-438。
3. 樂冠妤,陳慧峰,張文榮(2023)。高齡者健康行為之計量文獻分析（1990－2022）。運動研究，32(2)，11-37。
4. (2024)。以生態瞬時評估探討成人每日步行數與戶外情境接觸對於每日情感的關係。戶外遊憩研究，37(1)，1-32。