Association of psychosocial and perceived environmental factors with park-based physical activity among elderly in two cities in China and Germany

Parks have the potential to contribute significantly to the PA of the urban population. A positive relationship between the number of urban parks and PA was found by Sallis, Cervero, Ascher et al. [1] in a study of 14 cities worldwide. Due to free and accessible PA areas, parks have widely been recognized as key environmental sites where individuals can engage in a variety of recreational activities with health benefits in daily life [2].

On the other side, urban parks are still not well utilized for PA by park visitors and residents of surrounding neighborhoods. Findings from park use research have revealed that more than half of city inhabitants never visit parks for active or passive activities during a typical week [3]. Less than one third of surveyed or observed park visitors engage in PBPA [4]. But with respect to “healthy ageing” and “active ageing” [5], urban parks have been recognized as important PA places for senior city residents [6] to increase health-related benefits [7, 8]. Although especially elderly make up at least 20% of the population in many countries, in recent studies of park use they are underrepresented with no more than 5% [4, 9, 10].

In order to promote PA of elderly in parks, the associations of possible factors with PBPA have to be known. According to the socio-ecological approach, older adults’ perceptions of the park environment and psychosocial characteristics could influence their PBPA [1]. PA of elderly is, according to Kerr [11], characterized by low-intensity leisure and day-to-day activities, sport activities and transportation activities, depending on a particular degree of demographic factors such as age, gender or family status [12‐14]. Furthermore, psychosocial factors such as self-efficacy, perceived barriers as well as the benefits of PA, enjoyment of PA or social support significantly influence PA behavior [5, 12, 15]. Subjective perceptions of the environment also play a significant role for PA [16]. For older adults, the sense of security with regard to their own body and the environment seem to play another fundamental role. Further relevant factors, according to Sallis et al. [1], are the perceived comfort and attractiveness of environmental conditions. These aspects concern for example the design and use of the transport infrastructure [17] such as walkways, railings and rest stops. Other studies of PBPA, but not with respect to the elderly, revealed that perceived cleanliness in parks was negatively related to PA [18]. Ries et al. [19] and Lackey et al. [20] also posited that perceived access to parks was associated with PBPA. Although associations between physical environments and psychosocial factors are supported for recreational walking [21, 22], active transport [15], and overall PA [15, 22] of older adults, the relationships have not been systematically investigated in the context of PBPA, let alone for PA of the elderly and intercultural comparison [18]. Based on the results of various systematic reviews of PA correlates in older adults [22, 23], studies are needed to assess the association between specific environmental and personal characteristics with older adults’ active park use.

Regarding a socio-ecological approach, physical environmental conditions of urban areas also influence activity behavior [24, 25]. According to Yen et al. [25], the residential area with its various movement areas such as parks, pedestrian and cycle paths, their furnishing or design as well as the presence of further infrastructure (traffic, medical care, shopping, sports facilities) influence the activity behavior of elderly. But most empirical studies on PBPA and psychosocial as well as environmental correlates were conducted in a single region with similar urban conditions [26]. However, sample-specific variations in the findings on PBPA of elderly and their psychosocial and environmental characteristics can be identified using data from different geographical regions with different urban conditions (e.g. built environment, population density) [27, 28].

Thus, based on the reported results and a socio-ecological approach, the objective of the study was to investigate (1) the association of selected psychosocial and perceived park environmental factors with PBPA of older people from Hong Kong in China and Leipzig in Germany; (2) the moderating effect of city (urban area) on the associations of these factors with PBPA.

This study was conducted to examine the association of psychosocial factors and perceived park environmental factors with PBPA of elderly and to evaluate the moderating effect of urban area (city) on the associations of factors with PBPA of elderly.

Findings of the current study revealed that there are differences between Hong Kong and Leipzig, referring to the self-reported PBPA. The energy expenditure of PBPA of all the elderly in the parks was higher in Hong Kong than in Leipzig. This might be explained by the particular urban conditions in Hong Kong compared to Leipzig. In Hong Kong the climate is warmer and the population density is higher. As described in Hong Kong there is a greater number of high-rise buildings and various opportunities to come into contact with nature. These reasons were evident also in other research. Klenk et al. [39] analysed the PA of elderly in the “Walking on Sunshine” study. The walking times outside depend on weather conditions. In addition, cultural factors might come into play: Germans traditionally join sport clubs or gymnastic clubs [40] and are more likely to engage in PA, whereas, in Hong Kong making use of parks to engage in PA has been a long-standing Chinese cultural tradition [9]. In addition, the BMIs of the samples in both cities (Leipzig: 25.19; Hong Kong: 22.02) is lower for the group of elderly aged 60 and above in Germany (28.6, [41]) and Hong Kong (24.12, [42]), showing that PBPA is an element of a healthy lifestyle in both cities. The negative association between energy expenditure of PBPA and BMI is also consistent with previous studies [9, 10, 43].

The current study demonstrates consistent further results revealing that differences in energy expenditure of elderly, in both cities, is related also to other demographic variables [12]. Men have a higher energy expenditure during PBPA than women, married older adults are more active than singles and the energy expenditure during PBPA of elderly with a high education level is higher than for older adults with a lower education level.

Regarding psychosocial factors it can be stated that four out of five psychosocial variables are significantly associated with energy expenditure in PBPA of older adults, including self-efficacy, perceived barriers, benefits of PA, enjoyment of PA – but not social support. Except for the latter, these findings for PBPA are in line with previous literature across other different fields and conditions of PA [12, 15, 44]. Regarding the association of social support and PA there are different results in the literature. For the adoption of PA, social support is a significant predictor, for the maintenance of PA of older adults, enjoyment of PA and social networks seem to be more important [12, 45].

For promoting PBPA in the elderly such knowledge about psychosocial correlates might be helpful. For example, in order to enhance self-efficacy, the creation of success experiences and positive feedback or substitute reinforcement [46] are recommended. For perceived barriers, currently various techniques for influencing planning and management of perceived barriers are discussed in the literature [47, 48], but having knowledge about the concrete crucial barriers is the precondition to overcome them. A study of Devereux-Fitzgerald and colleagues [49] systematically reviewed the qualitative studies, which investigated the specific needs of older adults who adopted and adhered to sports and exercise programmes. These needs in turn can be regarded as barriers in the case of non-compliance. Thus, for older people intensive and competent care during PA and exercise is more important than for younger. They also want the instructor to be knowledgeable about the elderly and their common health conditions. In addition, the purpose and benefits of physical activity must be clear and the information has to be transparent [49].

In view of the environmental conditions in which physically active older adults practice their PBPA, the selected four perceived environmental correlates in this study are significantly associated with the self-reported PBPA of the elderly. So, the results for the park safety, attractiveness, park features and park time distance are also consistent with previous studies [16] and can also apply to the elderly. According to the realist synthesis of Yen et al. [25] the mobility of older adults is decisively influenced by the estimated safety of their residential area with its various movement areas such as parks, pedestrian and cycle paths, their furnishing or design as well as the presence of further infrastructure. The study of Bethancourt, Rosenberg, Beatty and Arterburn [50] provides hints, that it is a great barrier for the adoption of PA of elderly to have an unsafe, uninviting, unattractive environment or uneven paths.

Based on the current study findings regarding the association of psychosocial correlates and perceived park environmental correlates with PBPA, the results will be inspiring and informative for future PA intervention design for older adults in parks. Health promoters can particularly help the elderly to gain higher selfconfidence during PA, find more enjoyment in PA and improve perceived health benefits of PA by offering park-based programmes. In terms of environmental factors, park designers should consider a high park security, attractive features like sufficient PA facilities with good quality, and amenities that support elderly during PA. In addition, PA in the elderly is encouraged if the park is within close proximity or accessible distance of their residence or home. These aspects could also be shown in the associated observa-tional study [27].

The elderly’s energy expenditure was also positively related to city, which in our study stands for different geographical locations with different urban areas [28]. City was one of the strongest predictors with an own contribution to explain park-based energy expenditure of the elderly. As with many results of studies from other countries [51, 52], the conditions for PA in Asia (or China) may not be 1:1 transferable to Europe. For example, the places and structures in which physical activities are executed in Hong Kong are fundamentally different from German urban structures.

There are significant interactions of city with perceived park feature and perceived park time distance concerning park-based energy expenditure PA of elderly. In Hong Kong perceived park features seemed to have no significant importance for PA. In contrast, elderly in Leipzig who perceived higher park features are more likely to engage in PBPA compared with those who perceive lower park features. That means, if park features in Leipzig have a higher quality, the elderly are likely to do more PA. The possible reason for the different association among the two cities might be, that in Hong Kong a park is the “main” place to execute PA for elderly irrespective of the quality of the park features. In Leipzig the elderly also have the opportunity to do PA elsewhere, such as public sport clubs or commercial health and fitness centers. This explanation is also in line with the results for the perceived park time distance. In Hong Kong, there were no significant differences in perceived park time distance for PA energy expenditure. That means again older people in Hong Kong are satisfied because they have parks with multiple functions as the “main” place to be active, irrespective of perceived park time distance.

In Leipzig elderly who perceived lower park distance are more likely to engaged in PBPA compared to those who perceive higher park distance. This result is consistent with other findings on the importance of perceived environmental conditions in Europe. Van Dyck et al. [28] also reported differences for the park users because of the neighborhood walkability. Additionally, in Hong Kong, parks probably play a more significant role in providing an attractive environment for elderly to participate in PA. In Leipzig, parks are possible perceived more as a place to relax or walk instead of a place to do exercise and be vigorously active [27]. To attract the park areas for PA of elderly and to promote the PA engagement of elderly these results of different associations of perceived park features and perceived park time distance with PBPA of elderly should be considered by park planners and policy makers.

The present study has several strengths. The data were measured with valid and reliable questionnaire tools, translated into three languages (English, German, Cantonese). An identical study protocol was used in Hong Kong and Leipzig. Therefore, it is possible to compare the findings of two cities with different urban areas in different countries. These comparisons revealed significant differences about park users and park characteristics, especially in addition with a direct observation [27]. However, study limitations also need to be acknowledged. Cross-sectional analyses make it impossible to infer causal relationships between PBPA and the relevant attributes, including the psychosocial and perceived park environmental factors. The questionnaires used in this study to measure PBPA in older people were validated. Nevertheless, objective and direct measurement, for example with accelerometers, is still required to accurately measure the energy expenditure of PBPA of elderly in the parks [53]. Moreover, in addition to the difference of urban area (high building and population density vs. low building and population density) in two cities, culture difference exisits as well. There is a need to make specific environmental factors of cities and parks and there operationalization more concrete. Regarding the older adults who participated in the study, only limited information of park use was collected, making it impossible to know if they lived in the neighborhood around the parks or not. Of further concern, this study did not consider the impacts of selection bias on older adults’ park-based PA because of the cross-sectional nature of the current study. Selection bias may occur when active individuals choose to live in the places that are equipped with active ressources [38]. The bias in selection is likely to bring an over estimation of park environment because active older adults with the choosen place to live may consider parks as a resource for maintaining an active lifestyle.

In conclusion, the findings of the current study are profound, as there is indication that selected psychosocial and environmental factors are associated with PBPA of elderly, even in a mixed sample from two cities. Furthermore, city as urban area has an independent contribution to park-based PA of the elderly. City moderates the associations of these factors with PBPA of elderly in the way that, for elderly, parks in Hong Kong are more relevant for PA, irrespective of park features or perceived park time distance. In Leipzig, a city with a different urban structure, perceived park features and perceived park time distance are relevant for the PA of elderly in parks. Therefore, the interaction of perceived environmental factors and PBPA in different urban areas should be considered in more detail in the future. Park designers and policy makers on the municipal level could use the findings to choose adequate strategies to promote PA of elderly. In order to make parks more attractive, targeted interventions on adequate equipment and accessibility for older people could be particularly effective to promote park-bases PA of the elderly.