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The Built Environment, Physical Activity, and Aging in the United States: A State
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Journal of Aging and Physical Activity, 2015, 23, 323-329
http://dx.doi.org/10.1123/japa.2013-0151
© 2015 Human Kinetics, Inc.
The Built Environment, Physical Activity, and Aging
in the United States: A State of the Science Review
Elizabeth M. Haselwandter, Michael P. Corcoran, Sara C. Folta, Raymond Hyatt,
Mark Fenton, and Miriam E. Nelson
Introduction and Methodology
The vast majority of U.S. adults do not meet the 2008 Physical
Activity Guidelines for Americans despite a myriad of known
health benefits from exercise (Troiano et al., 2008). Less than 3%
of older adults (aged 60 or older) are meeting these recommenda-
tions, with the majority of both men and women aged 70+ achieving
less than 10 min per day of moderate-to-vigorous activity based on
accelerometer data (Troiano et al., 2008). The reasons behind this
physical inactivity epidemic are complex and multifaceted. One
likely contributor to sedentary behavior is the built environment
(Boehmer, Hoehner, Deshpande, Brennan Ramirez, & Brownson,
2007; Hoehner, Brennan Ramirez, Elliott, Handy, & Brownson,
2005), which refers to the physical environment in which an indi-
vidual spends his or her time (e.g., home, neighborhood), includ-
ing the internal or external features of this environment, such as
staircases, sidewalks, crosswalks, and traffic density. The prevailing
hypothesis centers on the notion that various characteristics of an
individual’s physical environment may encourage or act as a barrier
toward physical activity (Boehmer et al., 2007; Duncan, Spence, &
Mummery, 2005; Feng, Glass, Curriero, Stewart & Schwartz, 2010;
Lee, Ewing, & Sesso, 2009). With the high prevalence of obesity
and other chronic health conditions associated with inactivity, under-
standing how the built environment can influence health-related
behavior has become an important area of research.
The existing evidence leaves many questions unanswered or
provides conflicting results, and also highlights the need for additional
research to determine environmental variables of importance (Brennan
Ramirez, et al., 2006; Feng, et al., 2010). This is true across popula-
tions, but particularly true for older adults over the age of 65 (Cun-
ningham & Michael, 2004), and much of the research focuses on the
outside environment, leaving possibilities for exploring influences on
indoor activity in older populations, particularly those in senior hous-
ing. Older adults are the fastest growing, yet least active, segment of
Haselwandter is a Nestle doctoral fellow, Gerald J. and Dorothy R. Friedman
School of Nutrition Science and Policy, Tufts University, Medford, MA.
Corcoran is an assistant professor of health sciences at Merrimack College,
North Andover, MA. Folta is an assistant professor, Gerald J. and Dorothy R.
Friedman School of Nutrition Science and Policy, Tufts University, Medford,
MA. Hyatt is president of Freeport Development Strategies, LLC, Burlington,
MA. Fenton is an adjunct professor, Gerald J. and Dorothy R. Friedman School
of Nutrition Science and Policy, Tufts University, Medford, MA. Nelson is
a professor at the Gerald J. and Dorothy R. Friedman School of Nutrition
Science and Policy and associate dean at the Tisch College of Citizenship and
Public Service, both at Tufts University, Medford, MA. Address author cor-
respondence to Elizabeth M. Haselwandter at bizhaselwandter@gmail.com.
Official Journal of ICAPA
www.JAPA-Journal.com
SCHOLARLY REVIEW
the population. It is estimated that by 2050, there will be 88.5 million
Americans aged 65 and older and, of these, 19 million will be among
the “oldest old” (i.e., aged 85 and up) (Vincent & Velkoff, 2010). The
increase in the aging population will have a number of consequences,
such as a rise in health care costs since health care spending increases
with age (Orszag, 2008). Health care costs have risen over the past
30 years, from $714 billion in 1990 to more than $2.3 trillion in 2008
(Kimbuende, Ranji, Lundy, & Salganicoff, 2010). These rising costs
have alarmed policy makers and individuals alike, and provide an
incentive to prioritize successful aging, including reduced burden from
chronic diseases and greater functional independence.
Current physical activity recommendations for older adults in
the United States are identical to recommendations for all adults: to
achieve at least 150 min a week of moderate-intensity aerobic activ-
ity, 75 min of vigorous-intensity aerobic activity, or an equivalent
mix of both moderate- and vigorous-intensity activity (Centers for
Disease Control and Prevention, 2014). The benefits of physical
activity for older adults are wide ranging and include the follow-
ing: preserving muscle and bone mass, reducing rates of functional
decline, and improving glucose control, cardiovascular health, bal-
ance, and stability (Sattelmair, Pertman, & Forman, 2009). Increasing
physical activity in this population is very likely to support successful
aging, which includes limiting disease and disease-related disabil-
ity, ensuring physical and cognitive functioning is maintained, and
preserving an older adult’s ability to engage actively in life (Carr,
Weir, Azar, & Azar, 2013). One aspect of successful aging is aging
in place, or the ability to live in one’s own home confidently and
comfortably (Yen & Anderson, 2012). It is possible that a supportive
built environment will both enhance one’s physical functioning and
also make one’s home more comfortable for continued living.
Researchers hypothesize that built environment effects likely
differ by age and physical abilities, and that the built environment
can have both facilitating and constraining effects on the activities
of older adults (Brownson, Hoehner, Day, Forsyth, & Sallis, 2009;
Carr et al., 2013). The role that the built environment could play
in successful aging calls for a focus on determining which specific
elements enhance the health and well-being of older adults, and
identifying those factors that may impede older adults from activ-
ity. Maintaining mobility and independence are high priorities for
older adults, and so it is crucial to determine which environmental
factors could encourage these outcomes, and thereby prevent them
from moving from more independent or assisted living conditions to
nursing home facilities (Carr et al., 2013; Yen & Anderson, 2012).
This paper aims to: (1) review the current literature to determine
what relationships exist between the built environment and physical
activity in older adults; (2) identify features that may act as barriers
or enablers among older adults in senior-specific housing; and (3)
identify areas of future research for this population.
323
324  Haselwandter et al.
To determine what we have learned about the built environ-
ment, older adults, and physical activity (including walking) thus
far, the authors conducted a literature search using the following
search terms: built environment, older adults, assisted living facili-
ties, physical activity, and walkability. The literature search was
conducted using the PubMed research database, and included filter
criteria for participants aged 65+ and articles written in English.
The various search terms returned 166 articles. Articles were then
excluded if they were not conducted in the United States (n = 11),
focused on methodology (n = 11), or did not contain relevant vari-
ables, associations, or outcomes (n = 76).
The Built Environment and Older Adults:
Encouraging and Inhibiting
Physical Activity
The built environment can be defined in many ways, but it is useful
to think of it as encompassing various domains. Brownson et al.
(2009) suggest the following four domains: functional, destination,
aesthetics, and safety. Safety includes both safety from crime, such
as maintenance of local buildings, street lighting, and neighborhood
surveillance, and safety from traffic, such as safe crosswalks, bike
lanes, and sidewalks (Day, Boarnet, Alfonzo, & Forsyth, 2006).
Aesthetics generally refer to the “perceived attractiveness of the
setting for physical activity” and addresses issues such as litter,
broken glass, and plantings along walking paths (Day et al., 2006;
Hoehner, Ivy, Brennan Ramirez, Handy, & Brownson, 2007). Other
factors, such as accessibility, the prevalence of parks and green
spaces, land-use characteristics and land-use mix, foot and bike
trails, land slope, availability of public transport, and street con-
nectivity are also often included in built environment assessments
(Berke, Koepsell, Moudon, Hoskins, & Larson, 2007; Day et al.,
2006; Saelens, Sallis, Black, & Chen, 2003; Takano, Nakamura,
& Watanabe, 2002). There is some evidence linking each of these
domains with physical activity in older adults (Table 1).
More generally, a number of associations between the built
environment and physical activity measures have been investigated.
Studies have shown that factors such as safety from crime, presence
of light traffic, sidewalks, access to parks, access to indoor gyms
and treadmills, and less urban sprawl are associated with physical
activity levels in adults (Brownson, Baker, Housemann, Brennan, &
Bacak, 2001; Casagrande, Whitt-Glover, Lancaster, Odoms-Young,
& Gary, 2009; Lee et al., 2009). High walkability, an indication
of a more facilitating built environment, has also been consis-
tently associated with more minutes of moderate-to-vigorous and
moderate-intensity activity in adults (Carlson et al., 2012; Saelens
et al., 2003; Sallis et al., 2009). These results indicate that various
built environment factors may have an effect on physical activity
levels and overall health.
Many studies focus on the built environment’s relationship to
walking. Walkability was influenced by such factors as the presence
or absence of curb ramps, parking, lighting, weather, crosswalks,
sidewalks, amenities or land-use mix, walking paths or trails, safety,
density of intersections or street connectivity, traffic conditions,
and green space (Rosenberg, Huang, Simonovich, & Belza, 2013;
Rosso, Auchincloss, & Michael, 2011;). Older adults often perceive
the walking environment differently than the general population.
Michael, Beard, Choi, Farquhar and Carlson (2006) found that when
trained researchers’ measurements of the built environment were
compared with older adults’ perceptions, older adults reported side-
walk obstructions where the researchers saw none. This supports the
notion that older adults may have different concerns when walking,
and that a more thorough understanding of older adults’ perceptions
of the built environment are needed. Walking is a meaningful source
of activity for older adults; a number of studies cited walking as the
primary form of activity in this population (Michael, Gold, Perrin,
& Hillier, 2011; Sawchuk et al., 2011;). As an example, Michael et
al. (2011) found that 60% of the women aged 65 or older reported
walking for exercise or as a part of a daily routine. There is also
evidence for associations among other facilitating built environ-
mental factors and healthy behaviors and outcomes. Street density
and connectivity were significantly associated with the number
of blocks walked among women aged 65+ who reported walking
(Michael et al., 2011). Older adults living in senior living residences
reported greater self-rated health and less sedentary time if they also
reported more supportive outdoor physical activity features (Kerr et
al., 2011). Other positive associations between physical activity and
the built environment were related to land-use mix and destinations,
such as grocery stores, restaurants, and shops (Berke et al., 2007;
Sawchuk et al., 2011).
Barriers may also play a role, as issues such as fear of falling are
common, especially among older women (Walsh, Pressman, Cauley,
& Browner, 2001). Fear of traffic-related injuries may also play a
role in limiting outdoor physical activity (Shendell et al., 2011). In a
study by Theis and Furner (2011), building design, sidewalks, curbs,
and crowds were the most frequently cited environmental barriers
for adults aged 50 or older. However, the question remains as to
whether improvements in these barriers would translate to increased
physical activity, or which features play the most meaningful role.
A study by Rosenberg et al. (2013) attempted to gain in-depth,
qualitative data on barriers or facilitators to walking among seniors
with mobility disabilities. In focus groups, seniors perceived not
feeling visible to drivers; fast moving traffic; lack of driver atten-
tion; sidewalk surfaces and quality (particularly navigating over
brick, cobblestones, and metal grates); lack of sidewalk; rain, heat,
and sun exposure; hills; and outdoor stairs as barriers to walking
(Rosenberg et al., 2013). In particular, crossing the street was
mentioned as a particularly stressful event; crossing signal times
often felt too short, and participants felt rushed and at a greater
risk of falling (Rosenberg et al., 2013). They also felt that a lack
of street crossings were a problem, and some coped with issues
involving crossing streets by staying home (Rosenberge al., 2013).
Participants also mentioned a number of perceived facilitators:
smooth and wide sidewalks, presence of a grass strip between
the sidewalk and the road, presence of ramps, stair handrails, and
feeling safe from crime (Rosenberg et al., 2013). Places to rest
were a common theme, particularly in communal outdoor spaces,
such as parks or walking trails, and in lines at places such as food
banks (Rosenberg et al., 2013). Participants mentioned feeling
fatigued if they had to stand or walk for too long, and shelter
for rest and from the weather at public transportation stops and
on local streets were considered to be important facilitators, as
well as accessible drinking fountains and restrooms (Rosenberg
et al., 2013). While this study focused on seniors with mobility
disabilities, it is easy to imagine that frail, older adults who are
able to walk without assistive devices may cite similar concerns;
future focus groups could confirm this. While some aspects of
the built environment are more fixed and harder to change, other
aspects could be addressed, and provide opportunities for study.
In particular, improved sidewalk quality and extended crossing
times could be addressed, and then the impact of these changes
can measured by self-report of objective measures, such as
accelerometer data.
Table 1  A Review of Measures and Results in Studies Examining the Built Environment in Seniors
Sample
Reference Population Size Study Type BE Measure Outcome Results
Functionality
Berke et al., Adults aged 65 936 Cross- Walkability score Walking for exer- A walkability score in the 75th per-
2007 and older sectional (objectively measured) cise (self-report) centile increased the odds of walking
for exercise in men at all three buffer
zone sizes (100 m, 500 m, 1000
m) when compared with the 25th
percentile; for women, results were
only significant at the 1000 m buffer
Carlson et al., Adults aged 65 719 Cross- Walkability (GIS- MVPA minutes/ Walkability was positively associ-
2012 or older sectional derived) week (measured via ated with total minutes per week
accelerometer) of moderate-to-vigorous physical
activity
Carlson et al., Adults aged 65 719 Cross- Walkability (GIS- Walking for trans- Walkability was positively associ-
2012 or older sectional derived) portation (self- ated with self-reported walking for
report) transportation
Carlson et al., Adults aged 65 719 Cross- Walkability (GIS- Walking for leisure Walkability was positively associated
2012 or older sectional derived) (self-report) with self-reported walking for leisure
Frank, Kerr, Adults aged 65 1,970 Cross- Walkability (GIS- Walked at least Older adults living in a high walk-
Rosenberg, & or older sectional derived) once in 2 days (self- ability neighborhood were twice as
King, 2010 report) likely to walk at least once a day in
two days compared with those in low
walkability (but not medium walk-
ability) neighborhoods
Kerr et al., 2011 Seniors living in 147 Cross- APARS “Outside Sup- Sedentary minutes/ More supportive outdoor features
senior living resi- sectional portive PA Features” hour (measured via were associated with less sedentary
dences (mean age 12-item subscale accelerometer) time among residents living in Senior
of 80 years) (objectively measured) Living Residences.
Kerr et al., 2011 Seniors living in 147 Cross- APARS “Outside Sup- MVPA minutes/ More supportive outdoor features
senior living resi- sectional portive PA Features” hour (measured via were associated with greater minutes
dences (mean age 12-item subscale accelerometer) per hour of moderate to vigorous
of 80 years) (objectively measured) physical activity among residents in
senior living residences
Kerr et al., 2011 Seniors living in 147 Cross- APARS “Outside Exer- Sedentary minutes/ Having outside exercise facilities
senior living resi- sectional cise Facilities” 10-item hour (measured via was related to less sedentary time for
dences (mean age subscale (objectively accelerometer) residents in senior living residences
of 80 years) measured)
Kerr et al., 2011 Seniors living in 147 Cross- APARS “Outside Exer- MVPA minutes/ Having outside exercise facilities
senior living resi- sectional cise Facilities” 10-item hour (measured via was related to engaging in more mod-
dences (mean age subscale (objectively accelerometer) erate to vigorous physical activity for
of 80 years) measured) residents in senior living residences
King et al., Adults aged 66 719 Cross- Walkability (GIS- Walking for trans- Higher walkable neighborhood quad-
2011 and older sectional derived) portation (self- rants were associated with higher
report) average number of minutes per week
of walking for transportation com-
pared with lower walkable quadrants
Michael et al., Women aged 65 1,008 Cross- Street connectivity and Blocks walked Among women who walked at base-
2011 and older sectional street density (block (self-report) line (n = 1008, out of total sample of
length) (GIS-derived) 1671), both BE measures were asso-
ciated with blocks walked per week;
greater street density (shorter block
size) and greater connectivity were
associated with more blocks walked
Michael et al., Women aged 65 1,008 Prospective Street connectivity Dynamic leg Among women who walked, greater
2011 and older cohort (GIS-derived) strength (chair street connectivity was associated
stand score) with less decline in dynamic leg
strength

(continued)

325
Table 1  (continued)
Sample
Reference Population Size Study Type BE Measure Outcome Results
Functionality  (continued)
Michael et al., Women aged 65 1,008 Prospective Street density (block Dynamic leg Among women who walked, greater
2011 and older cohort length) (GIS-derived) strength (chair street density (shorter block size)
stand score) was associated with less decline in
dynamic leg strength
Michael et al., Women aged 65 663 Prospective Street connectivity and Lower extremity Neighborhood walkability (encom-
2011 and older cohort Street density (block physical perfor- passing both street connectivity and
length) (GIS-derived) mance (chair stand street density) were not associated
scores and timed with physical performance over time
walks) in women who reported not walking
at baseline in adjusted models
Shigematsu et Adults aged 66 360 Cross- Land use mix-access Transportation Greater land use mix access was
al., 2009 and older sectional (NEWS 6-item sub- walking (self- related to more reported walking for
scale measuring ease of report) transportation among the older study
access to nonresidential participants
uses) (perceived)
Destinations
Kerr et al., 2011 Seniors living in 147 Cross- APARS (Adult Physi- Sedentary minutes/ Increased number of onsite services
senior living resi- sectional cal Activity Resources hour (measured via was related to increased sedentary
dences (mean age for Seniors) “Onsite accelerometer) time for seniors living in senior living
of 80 years) services/destinations” residences
17-item subscale
(objectively measured)
Kerr et al., 2011 Seniors living in 147 Cross- APARS “Inside Social Sedentary minutes/ A greater number of inside social
senior living resi- sectional Facilities” 19-item hour (measured via facilities was related to increased
dences (mean age subscale (objectively accelerometer) sedentary time for residents of senior
of 80 years) measured) living residences
Shigematsu et Adults aged 66 360 Cross- Land use mix-diversity Transportation Greater land use mix diversity
al., 2009 and older sectional (NEWS 23-item walking (self- was related to greater self-reported
subscale measuring report) walking for transportation among
proximity to nonresi- older adults
dential land uses, such
as restaurants and retail
stores) (perceived)
Shigematsu et Adults aged 66 360 Cross- Recreational facilities Transportation Reporting more recreational facilities
al., 2009 and older sectional near home (perceived) walking (self- near home was positively associated
report) with transportation for walking
Aesthetics
Kerr et al., 2011 Seniors living in 147 Cross- APARS “Outside Aes- Sedentary minutes/ Outside aesthetics subscale score
senior living resi- sectional thetics” 3-item subscale hour (measured via was unrelated to sedentary time
dences (mean age (objectively measured) accelerometer) among residents of senior living
of 80 years) residences
Kerr et al., 2011 Seniors living in 147 Cross- APARS “Outside Aes- MVPA minutes/ Outside aesthetics subscale score
senior living resi- sectional thetics” 3-item subscale hour (measured via was unrelated to minutes per hour
dences (mean age (objectively measured) accelerometer) of moderate to vigorous physical
of 80 years) activity among residents of senior
living residences
Safety from traffic and crime
Kerr et al., 2011 Seniors living in 147 Cross- APARS “Outside Haz- Sedentary minutes/ Score on the outside hazards subscale
senior living resi- sectional ards” 4-item subscale hour (measured via was unrelated to sedentary time
dences (mean age (objectively measured) accelerometer) among residents of senior living
of 80 years) residences
Kerr et al., 2011 Seniors living in 147 Cross- APARS “Outside Haz- MVPA minutes/ Score on the outside hazards subscale
senior living resi- sectional ards” 4-item subscale hour (measured via was unrelated to moderate to vigor-
dences (mean age (objectively measured) accelerometer) ous physical activity among residents
of 80 years) of senior living residences
Note. BE = built environment; APARS = Adult Physical Activity Resources for Seniors; GIS = geographic information system; MVPA = moderate-to-vigorous physical activity.

326

Taylor et al. (2007) explored a similar theme among older
minority women (aged 50–75 years of age) living in Brooklyn and
the Bronx. Using qualitative data from 45 subjects in nine different
group sessions, a prioritized list of environmental recommenda-
tions that might make physical activity more appealing emerged.
While many of the responses were specific to the neighborhood
the women live in, a number of the top twelve recommendations
may apply to the general older adult population: cleaner streets,
more street lights, walking groups, free gyms, more bicycle paths,
fewer unleased dogs, streets closed for exercise, and senior citizen
facilities (Taylor et al., 2007). Taken together, these two qualitative
looks at potential challenges or concerns for older adults suggest
that there are a number of improvements that could be tested to
improve outdoor walking and physical activity in this population,
and that there may be an opportunity to focus on indoor forms of
activity that may make seniors feel more comfortable.
Walking is likely to be a vital and accessible means for older
adults, particularly those living in assisted living or senior living
residences, to achieve sufficient levels of activity. Walking is gener-
ally categorized as low-light physical activity or high-light physical
activity when measured using an accelerometer, and both of these
categories of activity have been associated with physical health and
well-being (Buman et al., 2010). This is important, as two studies have
found that older adults (aged 65 and up) engage in this type of activ-
ity for significant portions of the day (Buman et al., 2010). Buman et
al. (2010) found that older adults spent, on average, about 4.9 hr per
day in activity that fell between sedentary and moderate-to-vigorous.
The health benefits of such activity are not negligible. The benefits
of activity categorized as high-light physical activity are in the same
range as that of moderate-to-vigorous (Buman et al., 2010). Given this,
encouragement of walking behaviors, whether it be indoors or out,
should be highlighted to seniors as a way to improve overall health
and physical functioning. Future research should focus on measuring
these types of physical activity in older adults, so as to more thoroughly
capture the full range of physical activity in this population.
The Built Environment
and Senior-specific Housing
Currently, there are more than 6,000 assisted living facilities in
the United States (Assisted Living Federation of America, 2013).
However, very little research exists on how internal environmental
features may influence physical activity in this population. Kerr et
al. (2011) looked at built environment features and used an objective
measure of physical activity levels in seniors residing in senior living
residences. Here, supportive outdoor features were associated with
residents achieving greater levels of moderate-to-vigorous physical
activity, but no effect was seen for inside building features (Kerr et
al., 2011). However, the study focused more on exercise facilities
within the building rather than the overall building features (Kerr et
al., 2011). Furthermore, their focus on moderate-to-vigorous physi-
cal activity may have limited the ability to see an effect, and future
studies in these populations need to include all types of activity,
including activity defined as light intensity, as mentioned previously.
Future Directions for Research
Other studies provided support for the further examination of build-
ing features as they relate to activity levels. Building design as a
barrier to community participation in older adults was reported
more frequently than other factors, such as lighting or sound, and
Built Environment, PA, and Aging   327
was highest among those adults with arthritis, a common condition
in older adults (Theis & Furner, 2011). Takahashi, Baker, Cha and
Targonski (2012) noted that many senior apartments and assisted
living facilities are built at the edges of towns, and not within
walking distance of retail shops and other amenities. In such cases,
facility grounds and buildings would be the primary, if not only,
opportunity for meaningful physical activity. Given the concerns
that older adults have about outdoor physical activity and walking,
and the importance of light intensity activity to this population,
exploring ways to encourage walking within facilities and facility
grounds is an area for further focus.
While the reasons for inactivity are complex, the physical
environment must be considered should we hope to achieve a more
active aging population. More research is needed in this regard, with
emphasis placed not only on independent communities, but also on
institutionalized settings such as assisted living facilities. Assisted
living facilities offer a unique opportunity to test modifications to
the immediate environment of a group of older adults.
A possible framework of factors specific to senior housing
and assisted living facilities is shown in Figure 1. Some aspects are
familiar from general literature on the built environment, but facility
features and facility programming are relevant only to these types
of living situations. Assisted living facilities, in particular, offer
many more services and amenities to older adults for those who
need a greater degree of care. They often offer extensive program-
ming, some of which is geared toward physical activity. The same
is true for other types of senior housing, although they may or may
not provide services such as medication supervision, rehabilitation
programs, meal programs, and help with activities such as bathing,
dressing, or cleaning.
One of the major challenges with studying the built environment
is the difficulty by which research findings may be applied to already
existing structures or neighborhood layouts. In most cases, research
findings limited to existing environments will have to contend with
high costs, time, and effort, as well as “community buy-in” before
the area in question can be remodeled to a more physical activity-
conducive setting. This may be unrealistic for most environments,
particularly those with a complex infrastructure. Therefore, the
challenge lies in determining feasible and cost-effective methods
to improve environments that already exist. One such remediable
aspect for assisted living or other types of senior housing would
be aesthetics. Would improvements to the look and feel of internal
and external walking paths increase walking behaviors in residents?
Such changes would be testable, and perhaps palatable to facility
administrators.
The first step in determining the needs of a particular environ-
ment, whether this environment is internal or outdoors, is to rate
the environment. Research shows that rating the environment for
walkability is especially relevant to this population. However,
the tools to accurately measure the degree of walkability in an
institutional setting, such as an assisted living facility, are lacking.
Scant research exists to determine the relationship between physi-
cal activity and the built environment for older adults residing in
assisted living facilities. The only study attempting to look at the
built environment in assisted living facilities focused on identifying
built environmental variables, and thus far the tool has not been
tested for reliability or validity (Lu, 2010). The created built envi-
ronment checklist provided a snapshot of built environment features
in assisted living facilities, but did not attempt to measure physical
activity levels in residents (Lu, 2010). By developing such tools and
confirming their validity, researchers, planners, and organizations
can better target areas of improvement. The fundamental goal of all
328  Haselwandter et al.
Figure 1 — A conceptual framework for understanding environmental influences on physical activity in older adults in continuing care facilities.
improvements is to encourage physical activity for older adults in
a safe, supportive manner such that health outcomes are improved
and disease burden is reduced.
Research should focus on identifying built environment fac-
tors that can impede or encourage activity both inside the facility
and on facility grounds. Improvements to facilities and surround-
ings that encourage physical activity may be more easily tested,
and provide a foundation for research in the larger population of
older adults. These “close to home” areas are likely to impart the
greatest impact on physical activity levels for their residents and
consequently, reduce disease burden for the fastest growing segment
of the human population.
Acknowledgments
Doctoral research funding was provided by Nestle, S.A.
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