Health enhancing physical activity, sociodemographic factors and the neighbourhood environment

Abstract: BACKGROUND: A physically active lifestyle is beneficial for good health. Despite this, it seems that many people are not sufficiently active. Attempts to promote the population levels of physical activity have not been successful. This has led researchers to find new ways to tackle the problem. Ecological models place more emphasis on the physical environment s potential influence on physical activity behaviour than other behavioural models do, but a greater understanding of the effect of the environment on physical activity is needed. AIMS: This thesis examined; 1) adherence to the current physical activity guidelines in Sweden and how different sociodemographic factors influence the adherence, 2) the test-retest reliability of an instrument aimed at assessing the perception of the neighbourhood environment, 3) the association between neighbourhood environmental factors and Health Enhancing Physical Activity (HEPA), and 4) the effect of a major environmental change on population levels of physical activity. METHODS: During 2003, a nationally representative sample of Swedish adults completed the International Physical Activity Questionnaire (IPAQ) to which questions related to sociodemographic factors and the neighbourhood environment had been added. This was repeated in 2006 while a trial of a congestion road tax was ongoing in Stockholm. RESULTS: Overall, 63 % of the Swedish adults adhered to the physical activity recommendations. Large differences between sociodemographic groups were observed. The environmental module showed good test-retest reliability, with intra-class correlations ranging from 0.36 regarding questions of a subjective nature to 0.98 for questions of an objective nature, with minor differences in reliability seen between the genders. Walking was positively associated with the degree of urbanisation while HEPA was negatively associated with it. Those living in Stockholm during the congestion road tax increased their physical activity at moderate intensity and their HEPA and reduced their time spent sitting. No difference in levels of physical activity or sitting between those exposed and the comparison group during the trial was observed. CONCLUSIONS: The large variation in physical activity among different demographic groups in the population indicates the need for broad approaches to promote physical activity. The divergent association between the degree of urbanisation, walking and HEPA illustrates the importance of assessing overall physical activity as well as different subsets of physical activity. In accordance with theories of the ecological model, a major environmental change influenced the physical activity behaviour of an exposed population.