March 15, 2012 (San Diego, California) — Two new studies presented this week highlight the importance of urban design in the fight against obesity and cardiovascular disease, with investigators reporting that heart-healthy neighborhood features influence the amount of participation in physical activity.

In the first study, researchers identified neighborhoods with "heart healthy features," including access to recreational facilities and grocery stores, as well as fruit and vegetable markets, and found that individuals living in these neighborhoods were more likely to have ideal cardiovascular health compared with those who didn't have such access. In the second study, Dr Gregory Heath (University of Tennessee, Chattanooga) and colleagues compared two low-income neighborhoods and found that children were more likely to engage in physical activity in the neighborhood that had a newly designed, two-mile, extra-wide trail for bicycling and walking. The researchers say the findings highlight the importance of urban design in preventing long-term, chronic disease.

"From a clinician's point of view, we need to get our providers to recognize that patients don't live in their offices and don't live in their hospitals. They live in neighborhoods," Heath told heartwire . "Even if you're a conscientious, preventive medicine guru, whether an internist, a family doctor, or a pediatrician, we need to realize that if we prescribe an activity or a healthy living plan for a patient to prevent weight gain or obesity, we also have to understand where the patient lives in order to know if they can fulfill it. It's not simply a matter of motivation."

The results of the studies were presented this week at EPI|NPAM 2012, the Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism Scientific Sessions 2012.

New urbanist design

To heartwire, Heath said that few studies have examined the role of the urban environment on active living in neighborhoods with low socioeconomic conditions. Urban design and land use at the community level — for example, the development of walking trails, continuity of sidewalks, traffic-calming measures — as well as aesthetic factors, such as landscaping, are all factors in whether or not an individual considers his/her neighborhood to be safe for physical activity.

Reconstruction of an inner city community allowed the group to assess the impact of the "new urbanist" construction on active living among African American children in Chattanooga. A new walking/bicycling trail was built in the neighborhood with the intention of decreasing crime and enhancing livability in an area previously blighted by industry. The walking trail provides a link from the housing community to the local elementary school, as well as a library, recreational center, and retail area that includes a grocery store. The reconstructed area was compared with an older area that had traditional public housing and lacked a designated urban trail.

Using the System for Observing Physical Activity and Recreation in Communities (SOPARC) measurement scale, the researchers found that children and adolescents with access to the walking trail were significantly more likely to engage in physical activity than children who lived in the traditional housing block without access to a walking/biking trail. The difference between the two communities was most pronounced when examining SOPARC assessments along the trail routes.

The results, said Heath, are yet more evidence that changing a physical environment can result in changes in behavior. Such changes result in better communities, with families more likely to use physical activity as a mode of transportation and to increase fitness.

"What we can see is empowerment," said Heath, talking about the changes observed in the community. "Does it pay? I think it does. What we're seeing are parents who are willing to let their kids go and be kids, go to the park; whereas before there was . . . no safe way to get there. The school, which has a safe walk to school program, has told us, at least anecdotally, that there is greater participation in the program."

MESA analysis

In the second study, led by Erin Unger, a medical student at Northwestern University (Chicago, Illinois), researchers analyzed data from 6047 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) who had baseline measurements of cholesterol, body mass index (BMI), diet, physical activity levels, fasting glucose, blood pressure, and smoking status. Participants were grouped into three cardiovascular health categories — poor, intermediate, or ideal — based on the American Heart Association's definition of ideal cardiovascular health.

After adjusting for age, gender, race/ethnicity, income, education, and location, individuals with access to more favorable walking trails and sidewalks were two times more likely to be classified as in ideal cardiovascular health (odds ratio 2.16; 95% CI 1.79–2.62). Access to healthy food choices, such as grocery stories and fruit/vegetable markets, was also a predictor of individuals having ideal cardiovascular health (OR 1.66; 95% CI 1.41–1.95).

To heartwire , Unger reiterated the conclusions reached by Heath and colleagues: "We need to keep in mind, when we're talking to patients, that where they live has an impact on their overall cardiovascular health, and that changes at the neighborhood level might benefit their overall cardiovascular health in the future."

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