ENVIRONMENTAL BARRIERS TO EXERCISE FOR PEOPLE WITH ARTHRITIS
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1 ENVIRONMENTAL BARRIERS TO EXERCISE FOR PEOPLE WITH ARTHRITIS Molly Vaughan, DPT Doctoral Candidate, PhD in Rehabilitation Sciences Boston University, Sargent College Environmental Barriers: Background Physical activity is a non invasive strategy for people with arthritis Most people with arthritis do not meet recommended levels of physical activity People with arthritis may encounter barriers to exercise in their physical environment 1
2 Environmental Barriers: Background Environment: the physical, social, and attitudinal environment in which people live. (ICF, 2001) Support & Relationships Natural Environment Attitudes Products & Technology ENVIRONMENT Services, Systems, & Policies Environmental Barriers: Evidence Current research on environmental barriers to physical activity focuses on general and older adults Literature review of 40 studies Environmental barriers for people with arthritis Link between environment and community mobility or physical activity Count method of significant and insignificant findings used to summarize results of studies 2
3 Environmental Features: Evidence Sidewalk conditions (e.g., uneven sidewalks, physical obstacles) Safety (i.e., perceived safety of the neighborhood) Walking infrastructure (e.g., availability of sidewalks) Places to sit/rest (e.g., benches) Environmental Features: Evidence Fitness centers in the neighborhood Specific exercise classes/facilities tailored to people with arthritis Parks/green space (e.g., parks within walking distance) Accessibility (e.g., accessible entrances to local destinations) 3
4 Environmental Features: Evidence Walking paths/trails (e.g., presence of trails, maintenance) Mixed land use (e.g., amenities nearby, such as grocery or retail stores) Traffic conditions (e.g., volume, noise, traffic calming structures) Weather (e.g., temperatures, precipitation, ice) Environmental Barriers: Evidence Most studies do not include people with mobility limitations Few studies on people with arthritis are quantitative Heterogeneity in research methods Most research conducted in urban settings 4
5 Environmental Barriers: Conclusions Qualitative and cross sectional evidence: environmental features may relate to physical activity of people with arthritis Research gap: greater quantitative evidence is needed EXERCISE ADHERENCE IN ARTHRITIS: ENVIRONMENTAL INNOVATIONS TO PROMOTE PHYSICAL ACTIVITY Molly Vaughan, DPT Doctoral Candidate, PhD in Rehabilitation Sciences Boston University, Sargent College 5
6 Background: Environmental Features Sidewalk conditions (e.g., uneven sidewalks, physical obstacles) Safety (i.e., perceived safety of the neighborhood) Walking infrastructure (e.g., availability of sidewalks) Places to sit/rest (e.g., benches) Background: Environmental Features Fitness centers in the neighborhood Specific exercise classes/facilities tailored to people with arthritis Parks/green space (e.g., parks within walking distance) Accessibility (e.g., accessible entrances to local destinations) 6
7 Background: Environmental Features Walking paths/trails (e.g., presence of trails, maintenance) Mixed land use (e.g., amenities nearby, such as grocery or retail stores) Traffic conditions (e.g., volume, noise, traffic calming structures) Weather (e.g., temperatures, precipitation, ice) Technological Innovations & the Environment The physical environment can encourage physical activity into daily routines: Urban planning Building and product design Applications & websites Interactive public installations Limited research evidence 7
8 Product & Building Design NYC s Active Design Guidelines for building design 1 : Provide interesting corridors and unenclosed stairwells Provide bike storage and showers onsite Pedestrian friendly exteriors and location of building functions to encourage brief bouts of walking Product & Building Design Skip stop elevators 1 Elevators stop at every 3 rd floor Encourages physical activity through use of stairs Decreases non productive time spent waiting for elevator 1 8
9 Product & Building Design Skip stop elevators, evidence 1 : 24 week experiment in Californian 13 story building Surveyed 299 participants: 72% used stairwell daily Open stairwell used 33x more than enclosed stairwell 1 Nicoll G, Zimring C. Effect of innovative building design on physical activity. J Public Health Policy. 2009;(30): S111 S123. Product & Building Design Treadmill workstations: Systematic review (n=32 studies) found increased energy expenditure, no detrimental effect on work performance, improved health markers 1 1 Torbeyns et al. Sports Med 2014; 44(9):
10 Product & Building Design Bicycle Designs: Foldable bikes encourage multi modal transit Product & Building Design Bicycle Designs: Copenhagen Wheel Project (MIT) 1 Hybrid bike that stores energy Wheel has sensor that records information about user s effort level and surroundings Plan bike routes based on congestion, pollution, and road conditions through phone app ACR/ARHP 1 Boston 11/
11 Applications/Websites LocaLeikki: Website for finding places for physical activity while traveling Search by type of terrain, number of street crossings, distance, etc. User can add information about new places or rate locations Applications/Websites MapMyFitness: User plan or find routes to walk, run, or bike User can track activity location during exercise through phone GPS Track other health information, such as diet Share information with friends who are also members of application 11
12 Applications/Websites SeeClickFix: Allows user to point out nonemergency issues in community Alerts local governments to public concerns Track reported issue over time Promotes involvement in community Seeclickfix.com Interactive Public Installations Musical Light Swings (Montreal & Colorado) Each swing creates a musical note Encourages movement and social interaction & cooperation through music making 12
13 Interactive Public Installations Piano stairs: Steps emit musical notes Encouraged 66% more pedestrians to use stairs over escalators Auckland Ferry Building: Dancing projected 5 stories stairs_ k.jpg lights/ Technological Innovations & Environment Environment can enable physical activity in daily routines Technological innovations allow for environmental modifications at any scale More research is needed to assess evidence of environmental modifications for promoting adherence to physical activity 13
14 Thank you! Molly Vaughan, DPT Doctoral Candidate, PhD Rehabilitation Sciences Boston University, Sargent College of Health & Rehabilitation Sciences 14
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