Background
Regular participation of leisure-time physical activity (LTPA) has many benefits including postponing premature mortality [
1‐
3], reducing the development of chronic non-communicable diseases [
4‐
7], and improving quality of life [
8‐
10]. LTPA is particularly relevant for elders, as they tend to have significantly more leisure time available than people in younger age cohorts [
4]. Furthermore, LTPA may also provide the best opportunity to intervene compared with occupational and household physical activity [
11]. Having the largest and most rapidly growing ageing population in the world [
12], China is undergoing a rapid transition from a rural to an urban society. It is expected that more than 1 billion people will live in Chinese cities by 2050 [
13]. Rapid urbanization may be associated with higher prevalence of chronic age-related diseases (e.g., diabetes) and unhealthy lifestyle (e.g., decreased physical activity levels) [
14]. For example, most of the Chinese elderly did not engage in LTPA [
15]. For many older adults, the neighborhood of residence is their predominant environmental context. The physical and social conditions of the neighborhood environment may be more important to older adults and particularly those who are retired or becoming frail and therefore likely to be spending increasingly more time with neighbors in their immediate neighborhood [
16]. Exploring the unique effects of neighborhood attributes on elders’ LTPA could be helpful to urban planners and public health officials in their efforts to build age-friendly neighborhoods and cities.
The physical environment and social environments are the most important aspects of one’s surroundings that potentially influence LTPA participation [
4,
17]. The physical environment is defined as the objective and perceived characteristics of the physical context in which people spend their time (e.g. home, neighborhood), including aspects of urban design (e.g. presence of sidewalks), traffic density and speed, distance to and design of venues for physical activity (PA) (e.g. parks), crime and safety [
18]. Recently, more attention has been paid to physical environmental correlates of LTPA among elders, but there were no consistent results so far [
19]. For example, neighborhood walkability is related to LTPA in the US [
20‐
22], but is not related to LTPA in other countries [
23,
24]. Although, there was no unified definition of social environment [
25], which encompasses interpersonal relationships (e.g., social support and social networks), social inequalities (e.g., socioeconomic position and income inequality, racial discrimination), and neighborhood and community characteristics (e.g., social cohesion and social capital, neighborhood factors). The positive effects of social participation on health may be significant for elders because elders have more times to take part in social activities due to retirement or fewer familial constraints [
26,
27]. The study conducted among people aged 50 years and over in 11 European countries (including Sweden) has shown that social participation was positively associated with self-rated health [
28]. However, two studies in Sweden demonstrated that social participation was negatively associated LTPA among people aged 20–80 years [
29,
30]. Social cohesion as another neighborhood determinant of health [
31], is particularly relevant to elders because of its association with neighborhood social order and rates of violent crime [
32,
33]. Studies have shown social cohesion is associated with wellbeing [
34], depressive symptoms [
35] and walking activity [
17,
33].
Physical and social environments are not only hypothesized to influence health behaviors, they are also interrelated and influence each other [
36,
37]. A previous study [
38] found that adults living in high-walkable Irish neighborhoods reported higher levels of knowing their neighbors, political participation, trust in other people, and social participation compared to participants living in low-walkable area. Other studies have also supported the premise that pedestrian-friendly environments are related to increased social capital [
39‐
41]. However, few studies have simultaneously examined associations of individual, physical and social environmental characteristics with physical activity [
42].
Neighborhood attributes’ relation to physical activity are relatively well researched in Western countries, but remain largely underexplored in China. Some studies in China [
43‐
52] have explored the relationship between environmental characteristics and LTPA, but most of them [
47,
49‐
52] were conducted among Hong Kong elders. None of these studies have examined the relationship between social environment and LTPA. Very often environmental characteristics consist of individuals/units at a lower level nested within spatial units at a higher level (e.g., individuals nested within neighborhoods) [
19,
25]. Environmental characteristics should be measured at the interpersonal level, ecological level, or both. Multilevel methods are specifically geared toward the statistical analysis of data that have nested structures and sources of variability at multiple levels [
53]. Accordingly, in the present study we aim to examine the association between physical and social environments (both at individual- and neighborhood-levels) and LTPA among the Chinese elderly.
Discussion
The present study examined the relationship between social and physical attributes of neighborhood with LTPA among elders by multilevel analysis methods in Mainland China. One of our findings indicated that only individual-level social participation were associated with LTPA, which was consistent with previous studies [
29,
62] among whole population. Social participation measures the individual’s participation in several social activities within the life of modern society. There were several possible explanations why individual-level social participation was found to be associated with LTPA. Firstly, social participation may involve in participation of clubs or associations of recreational, physical and cultural activities. Secondly, social participation may increase one’s access to information about physical activity opportunities or the importance of physical activity for health [
62]. Social cohesion is another aspect of the social environment of a neighborhood that has the potential to influence individual health and health-related behaviors such as physical activity [
63]. Social cohesion refers to two inter-related features of society: (1) the absence of latent social conflict; and (2) the presence of strong social bonds-often measured by levels of trust and norms of reciprocity [
31]. Cohesive communities may be better to reinforce positive social norms for health behaviors (e.g., physical activity) and lead to quicker or more widespread adoption of healthy behaviors because neighbors know and trust each other [
25,
63]. In additional, neighbors that trust one another are more likely to provide helps and supports promoting access to services and amenities in time of need. Previous study among whole population in Sweden [
64] has shown that low trust was positively associated with low LTPA. Another study among middle-aged and older adults in Australia [
65] has shown that social cohesion was positively associated with LTPA. The current study indicated that individual-level social cohesion was also associated with LTPA among Chinese elderly.
Chinese have been proven to be more collectivistic [
66], but social capital in China resides largely in families or in other narrow circles of social relationships. It implies that people may only trust those who belong to the same in-group and may not participate social activities outside of their circles [
67]. When individual-level social participation and social cohesion were aggregated up to the neighborhood level, its effect on LTPA may tend to become diluted and less relevant. So there were no associations between neighborhood-level social participation and social cohesion with LTPA.
The current study examined the associations of two domains of physical neighborhood attributes, aesthetic quality and walkability with LTPA. Firstly, we found that there was no association between aesthetic quality and LTPA, which was consistent with previous studies among middle-aged adults in Shanghai [
44]. Another study among whole population in Shanghai also shown that aesthetic quality wasn’t associated with leisure-time walking [
48]. However, a previous study [
46] in Hangzhou found that aesthetic quality was positively associated with LTPA and LTW (both measured as MET-min) among adult women, but not among adult men. Another study [
47] among the elderly in Hong Kong showed that building attractiveness was positively associated with LWT, but not with LTPA other than walking. These contradictory findings suggest the overall aesthetic quality of a city may be important to LTPA, and a multicenter study including various cities may be needed to unpick these differences.
Walkable neighborhoods characterized by density, land used diversity, and well-connected transportation networks have been linked to more walking, less obesity, and lower coronary heart disease risk [
68‐
70]. We found that both individual-level and neighborhood-level walkability of neighborhood were positively associated with LTPA, which were consistent with previous study [
65]. However, a study among middle-aged adults in Shanghai indicated street connectivity was negatively associated with LTPA. One reason to explain these differences could be that the Chinese elderly are engaged in more LTPA than the Chinese youth [
71]. These findings suggest that building walkable neighborhoods may promote LTPA among the elderly.
There are some limitations to our study. First, the direction of causality could not be addressed due to the cross-sectional study design. Second, even though IPAQ was positively associated with accelerometer-assessed physical activity [
72], IPAQ often overestimates physical activity levels. Therefore the true number of individuals exercising >150 MET-min/week in this study population is likely an over-estimate. Third, because physical activity data were collected during the hottest months of summer (between July and September) rather than collected strategically across four seasons, so seasonal effects on physical activity should be noticed. Finally, a large sample from 47 neighborhoods were involved, but the study was conducted in only one administrative district of Shanghai, which may not be representative of the total elderly population in China. Multicenter well-designed prospective studies of neighborhood correlates of physical activity are warranted in the future.
Competing interest
The authors declare that they have no competing interests.
Authors’ contributions
JLG participated in the design of the study, performed the survey and the statistical analysis, and draft the manuscript. HF conceived of the study, and participated in its design and coordination. JL participated in the design of the study, performed the survey and helped to draft the manuscript. YNJ performed the survey. All authors read and approved the final manuscript.