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Land use mix and walking for transportation among older adults: an approach based on different metrics of the built environment

Uso misto do solo e a caminhada para fins de transporte em idosos: uma abordagem baseada em diferentes métricas do ambiente construído

Abstract

The presence of land use mix (LUM) in a neighborhood has been shown as an important aspect to promote walking as a daily means of transport. However, few studies in the area have applied different measurement strategies to test their effect on alternative modes of travel behavior, such as older adults walking. We applied six LUM measures of land use mix in two neighborhood definitions (500 and 1000m network buffers) and assessed their associations with walking for transport outcomes in adults over age 60 years from the EpiFloripa Aging study, living in the municipality of Florianópolis, Brazil, in 2013/14. Accounting for sociodemographic and environmental variables, adjusted associations found a positive relationship between four LUM and walking. The entropy index and three alternative measures defined by the intensity of commercial and nonresidential uses were positively associated with the walking for transportation, regardless of neighborhood definition. Stronger positive associations were seen when using smaller buffers and measures of the proportion of commercial uses, proportion of nonresidential uses and destination density. The results show that alternative measurements can overcome the entropy index, pointing out the need to adapt LUM measures and neighborhood scale to the geographic context and age group under analysis.

Keywords:
Walkability; Active transport; Physical Activity; Buffer; Entropy index

Resumo

A presença de diferentes usos do solo em um bairro tem se mostrado um aspecto importante para promover a caminhada como meio de transporte diário. No entanto, poucos estudos na área aplicaram diferentes estratégias de mensuração para testar seu efeito em modos alternativos de comportamento de viagem, como a caminhada de idosos. Aplicamos seis medidas de uso do solo em duas definições de bairro (buffers de rede de 500 e 1000m) e avaliamos suas associações com a caminhada para fins de transporte em participantes (≥ 60 anos) do estudo EpiFloripa Idoso (2013/14) de Florianópolis, Brasil. Considerando variáveis sociodemográficas e ambientais, as associações ajustadas encontraram uma relação positiva entre quatro medidas e a caminhada. O índice de entropia e três medidas alternativas de intensidade de usos não residenciais associaram-se positivamente com a caminhada para transporte, independentemente da definição de bairro. Associações positivas mais fortes foram observadas ao usar buffers menores e medidas de proporção de usos comerciais, proporção de usos não residenciais e densidade de destinos. Os resultados mostram que medidas alternativas podem superar o índice de entropia, apontando a necessidade de adaptação das métricas e da escala de vizinhança ao contexto geográfico e à faixa etária em análise.

Palavras-chave:
Caminhabilidade; Transporte Ativo; Atividade física; Buffer; Índice de entropia

Introduction

Aging is a worldwide demographic trend, posing the challenging issue of fostering wellbeing and health for a growing proportion of older adults. Active commuting in daily life is a key factor in promoting and encouraging healthy aging (Weiss et al., 2010Weiss, R. L., Maantay, J. A., & Fahs, M. (2010). Promoting Active Urban Aging: A Measurement Approach to Neighborhood Walkability for Older Adults. Cities and the Environment, 3(1), 12. http://www.ncbi.nlm.nih.gov/pubmed/21874149
http://www.ncbi.nlm.nih.gov/pubmed/21874...
; Giehl, 2014Giehl, M. W. C. (2014). Associação do ambiente construído e percebido com a caminhada em idosos de florianópolis: estudo populacional. (Tese de Doutorado em Saúde Coletiva), Programa de Pós Graduação em Saúde Coletiva. Universidade Federal de Santa Catarina. https://repositorio.ufsc.br/xmlui/bitstream/handle/123456789/129037/331659.pdf?sequence=1&isAllowed=y
https://repositorio.ufsc.br/xmlui/bitstr...
). Walking is indicated as a preventive and therapeutic measure for chronic diseases, recovery from disabilities and functional limitations, reduction of depression and anxiety, maintenance of independence and increased community involvement, and overall improvement in quality of life (Strawbridge et al., 2002Strawbridge, W. J., Deleger, S., Roberts, R. E., & Kaplan, G. A. (2002). Physical Activity Reduces the Risk of Subsequent Depression for Older Adults. American Journal of Epidemiology, 156(4), 328–334. https://doi.org/10.1093/aje/kwf047
https://doi.org/10.1093/aje/kwf047...
; Lee & Park, 2006Lee, Y., & Park, K. (2006). Health Practices That Predict Recovery from Functional Limitations in Older Adults. American Journal of Preventive Medicine, 31(1), 25–31. https://doi.org/10.1016/J.AMEPRE.2006.03.018
https://doi.org/10.1016/J.AMEPRE.2006.03...
). Among older adults, walking for transportation purposes is the most popular type of walking and is strongly associated with attributes of the built environment (Michael et al., 2006Michael, Y. L., Beard, T., Choi, D., Farquhar, S., & Carlson, N. (2006). Measuring the influence of built neighborhood environments on walking in older adults. Journal Of Aging And Physical Activity, 14(3), 302–312. https://pdxscholar.library.pdx.edu/commhealth_fac
https://pdxscholar.library.pdx.edu/commh...
; Barnett et al., 2017Barnett, D. W., Barnett, A., Nathan, A., Van Cauwenberg, J., & Cerin, E. (2017). Built environmental correlates of older adults’ total physical activity and walking: A systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity, 14(103). https://doi.org/10.1186/s12966-017-0558-z
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; Gharaveis, 2020Gharaveis, A. (2020). A systematic framework for understanding environmental design influences on physical activity in the elderly population: A review of literature. Facilities, 38(9–10), 625–649. https://doi.org/10.1108/F-08-2018-0094
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; Y L; Yun, 2019Yun, H. Y. (2019). Environmental factors associated with older adult’s walking behaviors: A systematic review of quantitative studies. Sustainability (Switzerland), 11(12). https://doi.org/10.3390/su10023253
https://doi.org/10.3390/su10023253...
).

As we age, our spatial area is reduced to the immediate vicinity, making the study of attributes at the community scale progressively more relevant (Lawton et al., 1978Lawton, M. P., Brody, E. M., & Turner-Massey, P. (1978). The Relationships of Environmental Factors to Changes in Well-Being. The Gerontologist, 18(2), 133–137. https://doi.org/10.1093/geront/18.2.133
https://doi.org/10.1093/geront/18.2.133...
; Handy et al., 2002Handy, S. L., Boarnet, M. G., Ewing, R., & Killingsworth, R. E. (2002). How the built environment affects physical activity: Views from urban planning. American Journal of Preventive Medicine, 23(2), 64–73. https://doi.org/10.1016/S0749-3797(02)00475-0
https://doi.org/10.1016/S0749-3797(02)00...
; Weiss et al., 2010Weiss, R. L., Maantay, J. A., & Fahs, M. (2010). Promoting Active Urban Aging: A Measurement Approach to Neighborhood Walkability for Older Adults. Cities and the Environment, 3(1), 12. http://www.ncbi.nlm.nih.gov/pubmed/21874149
http://www.ncbi.nlm.nih.gov/pubmed/21874...
). The access to diverse local destinations, such as stores, offices, services, and social interaction places within walking distance from the residence is one of the major factors affecting walking for transport (Handy & Clifton, 2001; Michael et al., 2006Michael, Y. L., Beard, T., Choi, D., Farquhar, S., & Carlson, N. (2006). Measuring the influence of built neighborhood environments on walking in older adults. Journal Of Aging And Physical Activity, 14(3), 302–312. https://pdxscholar.library.pdx.edu/commhealth_fac
https://pdxscholar.library.pdx.edu/commh...
; Van Cauwenberg et al., 2012Van Cauwenberg, J., Van Holle, V., Simons, D., Deridder, R., Clarys, P., Goubert, L., Nasar, J., Salmon, J., De Bourdeaudhuij, I., & Deforche, B. (2012). Environmental factors influencing older adults’ walking for transportation: a study using walk-along interviews. International Journal of Behavioral Nutrition and Physical Activity, 9(1), 85. https://doi.org/10.1186/1479-5868-9-85
https://doi.org/10.1186/1479-5868-9-85...
; Bordoloi et al., 2013Bordoloi, R., Mote, A., Sarkar, P. P., & Mallikarjuna, C. (2013). Quantification of Land Use Diversity in The Context of Mixed Land Use. Procedia - Social and Behavioral Sciences, 104, 563–572. https://doi.org/10.1016/j.sbspro.2013.11.150
https://doi.org/10.1016/j.sbspro.2013.11...
; Barnett et al., 2017Barnett, D. W., Barnett, A., Nathan, A., Van Cauwenberg, J., & Cerin, E. (2017). Built environmental correlates of older adults’ total physical activity and walking: A systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity, 14(103). https://doi.org/10.1186/s12966-017-0558-z
https://doi.org/10.1186/s12966-017-0558-...
; Cerin, Nathan, et al., 2017Cerin, E., Nathan, A., van Cauwenberg, J., Barnett, D. W., & Barnett, A. (2017). The neighbourhood physical environment and active travel in older adults: A systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity, 14(1), 1–23. https://doi.org/10.1186/s12966-017-0471-5
https://doi.org/10.1186/s12966-017-0471-...
; Yun, 2019Yun, H. Y. (2019). Environmental factors associated with older adult’s walking behaviors: A systematic review of quantitative studies. Sustainability (Switzerland), 11(12). https://doi.org/10.3390/su10023253
https://doi.org/10.3390/su10023253...
). Systematic reviews highlight that the proximity to nonresidential destinations can promote active transport among older adults (≥65 years old) (Barnett et al., 2017Barnett, D. W., Barnett, A., Nathan, A., Van Cauwenberg, J., & Cerin, E. (2017). Built environmental correlates of older adults’ total physical activity and walking: A systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity, 14(103). https://doi.org/10.1186/s12966-017-0558-z
https://doi.org/10.1186/s12966-017-0558-...
; Cerin, Nathan, et al., 2017Cerin, E., Nathan, A., van Cauwenberg, J., Barnett, D. W., & Barnett, A. (2017). The neighbourhood physical environment and active travel in older adults: A systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity, 14(1), 1–23. https://doi.org/10.1186/s12966-017-0471-5
https://doi.org/10.1186/s12966-017-0471-...
; Yun, 2019Yun, H. Y. (2019). Environmental factors associated with older adult’s walking behaviors: A systematic review of quantitative studies. Sustainability (Switzerland), 11(12). https://doi.org/10.3390/su10023253
https://doi.org/10.3390/su10023253...
). Therefore, older people living in mixed use neighborhoods can increase their physical mobility, psychological well-being, independence and interaction with the community through walking for transport (Frank, Kerr, et al., 2010Frank, L. D., Kerr, J., Rosenberg, D., & King, A. (2010). Healthy Aging and Where You Live: Community Design Relationships With Physical Activity and Body Weight in Older Americans. Journal of Physical Activity and Health, 7(s1), S82–S90. https://doi.org/10.1123/jpah.7.s1.s82
https://doi.org/10.1123/jpah.7.s1.s82...
).

Land use mix (LUM) has been defined in a variety of ways and, as a result, its measures are not standardized (Handy et al., 2002Handy, S. L., Boarnet, M. G., Ewing, R., & Killingsworth, R. E. (2002). How the built environment affects physical activity: Views from urban planning. American Journal of Preventive Medicine, 23(2), 64–73. https://doi.org/10.1016/S0749-3797(02)00475-0
https://doi.org/10.1016/S0749-3797(02)00...
). The most widely accepted and commonly used measure of LUM is the Entropy index (Bordoloi et al., 2013Bordoloi, R., Mote, A., Sarkar, P. P., & Mallikarjuna, C. (2013). Quantification of Land Use Diversity in The Context of Mixed Land Use. Procedia - Social and Behavioral Sciences, 104, 563–572. https://doi.org/10.1016/j.sbspro.2013.11.150
https://doi.org/10.1016/j.sbspro.2013.11...
) whose formula captures the evenness of distributions of different uses in a given territorial unit, disregarding the impacts of the presence of qualitatively different uses for walkability. Thus, for instance, a neighborhood with an uneven proportion of parks, schools, residences and commerce will have a lower score when compared to a neighborhood with balanced commercial, unifamiliar and multifamiliar uses, but no recreational or educational uses. Some important distortions may arise from such way of measuring land use diversity, since areas in which residential and commercial land use is 60%/40%, respectively, will have an equal numerical result as an area in which the proportions of theses use are reversed (40%/60%) (Brown et al., 2009Brown, B. B., Yamada, I., Smith, K. R., Zick, C. D., Kowaleski-Jones, L., & Fan, J. X. (2009). Mixed land use and walkability: Variations in land use measures and relationships with BMI, overweight, and obesity. Health and Place, 15(4), 1130–1141. https://doi.org/10.1016/j.healthplace.2009.06.008
https://doi.org/10.1016/j.healthplace.20...
). Some authors also argue that broad quantitative measures of land use, such as entropy, can hide important qualitative differences within land use categories, leading to the debate of the suitability of the index as an indicator of the micro scale (parcels and blocks) LUM (Cervero & Kockelman, 1997Cervero, R., & Kockelman, K. (1997). Travel demand and the 3Ds: Density, diversity, and design. Transportation Research Part D: Transport and Environment, 2(3), 199–219. https://doi.org/10.1016/S1361-9209(97)00009-6
https://doi.org/10.1016/S1361-9209(97)00...
; Brown et al., 2009Brown, B. B., Yamada, I., Smith, K. R., Zick, C. D., Kowaleski-Jones, L., & Fan, J. X. (2009). Mixed land use and walkability: Variations in land use measures and relationships with BMI, overweight, and obesity. Health and Place, 15(4), 1130–1141. https://doi.org/10.1016/j.healthplace.2009.06.008
https://doi.org/10.1016/j.healthplace.20...
). For instance, corner stores and automobile sales lots are usually classified under the same general category of commercial uses, despite very different potentials in generating and attracting walking trips. These limitations point out the need to explore alternative or complementary LUM measures (Christian et al., 2011Christian, H. E., Bull, F. C., Middleton, N. J., Knuiman, M. W., Divitini, M. L., Hooper, P., Amarasinghe, A., & Giles-Corti, B. (2011). How important is the land use mix measure in understanding walking behaviour? Results from the RESIDE study. International Journal of Behavioral Nutrition and Physical Activity, 8. https://doi.org/10.1186/1479-5868-8-55
https://doi.org/10.1186/1479-5868-8-55...
; Gehrke & Clifton, 2016Gehrke, S. R., & Clifton, K. J. (2016). Toward a spatial-temporal measure of land-use mix. Journal of Transport and Land Use, 9(1), 171–186. https://doi.org/10.5198/jtlu.2015.725
https://doi.org/10.5198/jtlu.2015.725...
; Wei et al., 2016Wei, Y. D., Xiao, W., Wen, M., & Wei, R. (2016). Walkability, land use and physical activity. Sustainability (Switzerland), 8(1), 1–16. https://doi.org/10.3390/su8010065
https://doi.org/10.3390/su8010065...
).

The lack of geographic comprehensiveness in available studies makes it difficult to generalize the findings (Gehrke & Clifton, 2016Gehrke, S. R., & Clifton, K. J. (2016). Toward a spatial-temporal measure of land-use mix. Journal of Transport and Land Use, 9(1), 171–186. https://doi.org/10.5198/jtlu.2015.725
https://doi.org/10.5198/jtlu.2015.725...
; Song et al., 2013Song, Y., Merlin, L., & Rodriguez, D. (2013). Comparing measures of urban land use mix. Computers, Environment and Urban Systems, 42, 1–13. https://doi.org/10.1016/j.compenvurbsys.2013.08.001
https://doi.org/10.1016/j.compenvurbsys....
). Brazilian research on the topic is scarce and few studies address this type of physical activity among older adults (Parra et al., 2011Parra, D. C., Hoehner, C. M., Hallal, P. C., Ribeiro, I. C., Reis, R., Brownson, R. C., Pratt, M., & Simoes, E. J. (2011). Perceived environmental correlates of physical activity for leisure and transportation in Curitiba, Brazil. Preventive Medicine, 52(3–4), 234–238. https://doi.org/10.1016/j.ypmed.2010.12.008
https://doi.org/10.1016/j.ypmed.2010.12....
; Giehl, 2014Giehl, M. W. C. (2014). Associação do ambiente construído e percebido com a caminhada em idosos de florianópolis: estudo populacional. (Tese de Doutorado em Saúde Coletiva), Programa de Pós Graduação em Saúde Coletiva. Universidade Federal de Santa Catarina. https://repositorio.ufsc.br/xmlui/bitstream/handle/123456789/129037/331659.pdf?sequence=1&isAllowed=y
https://repositorio.ufsc.br/xmlui/bitstr...
; Hino et al., 2014Hino, A. A. F., Reis, R. S., Sarmiento, O. L., Parra, D. C., & Brownson, R. C. (2014). Built environment and physical activity for transportation in adults from Curitiba, Brazil. Journal of Urban Health, 91(3), 446–462. https://doi.org/10.1007/s11524-013-9831-x
https://doi.org/10.1007/s11524-013-9831-...
; Rech et al., 2014Rech, C. R., Reis, R. S., Hino, A. A. F., & Hallal, P. C. (2014). Personal, social and environmental correlates of physical activity in adults from Curitiba, Brazil. Preventive Medicine, 58, 53–57. https://doi.org/10.1016/j.ypmed.2013.10.023
https://doi.org/10.1016/j.ypmed.2013.10....
). In addition, much of the evidence uses self-reported data about the environment, which have a low degree of agreement when comparing with neighborhood objective measures (based on GIS) (Kirtland et al., 2003Kirtland, K. A., Porter, D. E., Addy, C. L., Neet, M. J., Williams, J. E., Sharpe, P. A., Neff, L. J., Kimsey, C. D., & Ainsworth, B. E. (2003). Environmental measures of physical activity supports. American Journal of Preventive Medicine, 24(4), 323–331. https://doi.org/10.1016/S0749-3797(03)00021-7
https://doi.org/10.1016/S0749-3797(03)00...
; Michael et al., 2006Michael, Y. L., Beard, T., Choi, D., Farquhar, S., & Carlson, N. (2006). Measuring the influence of built neighborhood environments on walking in older adults. Journal Of Aging And Physical Activity, 14(3), 302–312. https://pdxscholar.library.pdx.edu/commhealth_fac
https://pdxscholar.library.pdx.edu/commh...
). Objective measures of the built environment are mostly developed and applied in high-income countries, indicating limited evidence and the need to verify the application of these methods in other urban contexts with different spatial, cultural and demographic aspects (Christian et al., 2011Christian, H. E., Bull, F. C., Middleton, N. J., Knuiman, M. W., Divitini, M. L., Hooper, P., Amarasinghe, A., & Giles-Corti, B. (2011). How important is the land use mix measure in understanding walking behaviour? Results from the RESIDE study. International Journal of Behavioral Nutrition and Physical Activity, 8. https://doi.org/10.1186/1479-5868-8-55
https://doi.org/10.1186/1479-5868-8-55...
; Koohsari et al., 2016Koohsari, M. J., Owen, N., Cerin, E., Giles-Corti, B., & Sugiyama, T. (2016). Walkability and walking for transport: characterizing the built environment using space syntax. International Journal of Behavioral Nutrition and Physical Activity, 13(1), 121. https://doi.org/10.1186/s12966-016-0448-9
https://doi.org/10.1186/s12966-016-0448-...
; Yun, 2019Yun, H. Y. (2019). Environmental factors associated with older adult’s walking behaviors: A systematic review of quantitative studies. Sustainability (Switzerland), 11(12). https://doi.org/10.3390/su10023253
https://doi.org/10.3390/su10023253...
).

Therefore, the main purpose of this study is to evaluate the performance of different land use mix (LUM) metrics, in search for those best able to reveal associations with walking in older adults. Additionally, we analyzed several environmental and sociodemographic factors, as well as the effects of different network buffers to explore the scale that most effectively represents the neighborhood area of this age group.

Methods

We used a representative sample of 919 older adults in Florianópolis, Brazil, obtained through the EpiFloripa Aging cohort study. Through face-to-face surveys, the study investigated the health and living conditions of older people (≥60 years) of Santa Catarina state’s capital, located in the South of Brazil. The city has 574.200 inhabitants (IBGE, 2022Instituto Brasileiro de Geografia e Estatística - IBGE. (2022). Prévia da população calculada com base nos resultados do Censo Demográfico 2022. Rio de Janeiro: IBGE. Retrieved on 11 July 2022 at https://www.ibge.gov.br/estatisticas/sociais/populacao/22827-censo-demografico-2022
https://www.ibge.gov.br/estatisticas/soc...
) with 11.4% of the population over the age of 60 (IBGE, 2010Instituto Brasileiro de Geografia e Estatística - IBGE. (2010). Censo Demográfico. Rio de Janeiro: IBGE. Retrieved on 11 July 2022 at www.ibge.gov.br
www.ibge.gov.br...
).

Data from the second wave of the survey (2013/2014) were selected due to the temporal approximation with the built environment database (2010-12). Among the 1197 respondents, we excluded participants who, at the time of the interview, reported not having physical ability to walk; lived for less than a year in the reported neighborhood; had incomplete data; or had moved to other cities prior to the second wave. The research design was approved by the Ethics Committee and all participants consented to participate in it. Study design, sample, and data collection methods are documented in more detail elsewhere (Confortin et al., 2017Confortin, S. C., Schneider, I. J. C., Antes, D. L., Cembranel, F., Ono, L. M., Marques, L. P., Borges, L. J., Krug, R. de R., & D’Orsi, E. (2017). Condições de vida e saúde de idosos: resultados do estudo de coorte EpiFloripa Idoso. Epidemiologia e Servicos de Saude : Revista Do Sistema Unico de Saude Do Brasil, 26(2), 305–317. https://doi.org/10.5123/S1679-49742017000200008
https://doi.org/10.5123/S1679-4974201700...
; Schneider et al., 2017Schneider, I. J. C., Confortin, S. C., Bernardo, C. D. O., Bolsoni, C. C., Antes, D. L., Pereira, K. G., Ono, L. M., Marques, L. P., Borges, L. J., Giehl, M. W. C., Krug, R. D. R., Goes, V. F., Boing, A. C., Boing, A. F., & D’Orsi, E. (2017). EpiFloripa Aging cohort study: methods, operational aspects, and follow-up strategies. Revista de Saude Publica, 51, 104. https://doi.org/10.11606/S1518-8787.2017051006776
https://doi.org/10.11606/S1518-8787.2017...
).

Study Variables

Spatial unit

To measure the individual’s neighborhood environment, two scales of street network buffers were used around each participant’s address: 500 and 1000 meters, corresponding to 10- and 15-minutes walking. The spatial unit was based on literature reviews (Cerin, Nathan, et al., 2017Cerin, E., Nathan, A., van Cauwenberg, J., Barnett, D. W., & Barnett, A. (2017). The neighbourhood physical environment and active travel in older adults: A systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity, 14(1), 1–23. https://doi.org/10.1186/s12966-017-0471-5
https://doi.org/10.1186/s12966-017-0471-...
; Yun, 2019Yun, H. Y. (2019). Environmental factors associated with older adult’s walking behaviors: A systematic review of quantitative studies. Sustainability (Switzerland), 11(12). https://doi.org/10.3390/su10023253
https://doi.org/10.3390/su10023253...
) and on the average walking speed of older people (0.86 meters/second) (Weber, 2016Weber, D. (2016). Differences in physical aging measured by walking speed : evidence from the English Longitudinal Study of Ageing. BMC Geriatrics, 1–9. https://doi.org/10.1186/s12877-016-0201-x
https://doi.org/10.1186/s12877-016-0201-...
), maintaining comparability with existing literature. Therefore, the calculation of land use measures considered all the parcels comprised by the buffers, aggregating their respective data.

Walking for transportation

Data were obtained from the long version of the International Physical Activity Questionnaire (IPAQ) embedded in the Epifloripa survey, which has high comparability in different countries and good reproducibility in samples of older Brazilians (Benedetti et al., 2004Benedetti, T. B., Mazo, G. Z., & Barros, M. V. G. De. (2004). Aplicação do Questionário Internacional de Atividades Físicas para avaliação do nível de atividades físicas de mulheres idosas : validade concorrente e reprodutibilidade teste-reteste. Revista Brasileira de Ciência e Movimento, 12(1), 25–34.; Benedetti et al., 2007Benedetti, T. R. B., Antunes, P. D. C., Rodriguez-Añez, C. R., Mazo, G. Z., & Petroski, É. L. (2007). Reprodutibilidade e validade do Questionário Internacional de Atividade Física (IPAQ) em homens idosos. Revista Brasileira de Medicina Do Esporte, 13(1), 11–16. https://doi.org/10.1590/s1517-86922007000100004
https://doi.org/10.1590/s1517-8692200700...
). Respondents were instructed to report the activities performed in a normal/usual week, with a minimum duration of ten minutes.1 1 Questionnaire is available at: http://www.epifloripa.ufsc.br/category/inqueritos/epi_idoso/epifloripa-idoso-2013/questionario_id13 Participants were then classified through a binary variable representing those that spent at least 10 minutes walking per week to access places such as stores, services, community centers, churches, and friends’ and families’ houses, and those that did not (Table 1).

Table 1
– Study variables: description, calculation and sources

Land-use Mix

Six LUM measures were used: (1) Entropy index (Jost, 2006Jost, B. (2006). Entropy and diversity. Oikos, 113(2), 363–375. https://doi.org/10.1111/j.2006.0030-1299.14714.x
https://doi.org/10.1111/j.2006.0030-1299...
); (2) Richness, defined as the total number of different uses in the buffer (Ritsema van Eck & Koomen, 2008Ritsema van Eck, J., & Koomen, E. (2008). Characterising urban concentration and land-use diversity in simulations of future land use. Annals of Regional Science, 42(1), 123–140. https://doi.org/10.1007/s00168-007-0141-7
https://doi.org/10.1007/s00168-007-0141-...
); (3) Retail building coverage ratio (BCR); (4) Proportion of commercial and residential units; (5) Proportion of nonresidential and residential units (Hoek, 2008Hoek, J. W. van den. (2008). The MXI (Mixed-use Index) as Tool for Urban Planning and Analysis. Corporations and Cities: Envsioning Corporate Real Estate in the Urban Future, May, 15. http://www.bk.tudelft.nl/fileadmin/Faculteit/BK/Actueel/Symposia_en_congressen/CRE_2008/Papers/doc/Paper03_vandenHoek.pdf
http://www.bk.tudelft.nl/fileadmin/Facul...
); and (6) Destination density (Hirsch et al., 2016Hirsch, J. A., Winters, M., Ashe, M. C., Clarke, P. J., & McKay, H. A. (2016). Destinations That Older Adults Experience Within Their GPS Activity Spaces: Relation to Objectively Measured Physical Activity. Environment and Behavior, 48(1), 55–77. https://doi.org/10.1177/0013916515607312
https://doi.org/10.1177/0013916515607312...
) (Table 1).

Since, as argued before, measures that view Land Use Mix as equal balance of land uses have important limitations (Saboya, 2021), we also employed other types of measures to examine their performance and potential complementarity in characterizing this aspect. Richness quantifies the number of distinct land use types in the buffer and was included to account for a dimension of diversity that is poorly considered in the entropy measure. The Retail BCR measure, defined by the retail building floor area footprint divided by the plot size, indicates the presence of developments with substantial parking or greater setbacks, two factors believed to hinder pedestrian access (Frank et al., 2010Frank, L. D., Kerr, J., Rosenberg, D., & King, A. (2010). Healthy Aging and Where You Live: Community Design Relationships With Physical Activity and Body Weight in Older Americans. Journal of Physical Activity and Health, 7(s1), S82–S90. https://doi.org/10.1123/jpah.7.s1.s82
https://doi.org/10.1123/jpah.7.s1.s82...
). The measure, despite not strictly a diversity measure, was added to explore the intensity of commercial use and verify its suitability to the Brazilian context. Two other proportion measures were also used, considering broader categories of land use than the ones usually included in entropy measures, the rationale being that a more balanced proportion (50/50) between commercial (or non-residential) and residential uses is associated with higher degrees of street life (Hoek, 2008Hoek, J. W. van den. (2008). The MXI (Mixed-use Index) as Tool for Urban Planning and Analysis. Corporations and Cities: Envsioning Corporate Real Estate in the Urban Future, May, 15. http://www.bk.tudelft.nl/fileadmin/Faculteit/BK/Actueel/Symposia_en_congressen/CRE_2008/Papers/doc/Paper03_vandenHoek.pdf
http://www.bk.tudelft.nl/fileadmin/Facul...
). Finally, the destination density takes into account the total number of non-residential destinations within reach in the buffer divided by its area, an aspect that is largely neglected in the other measures.

Individual variables

Individual variables included were gender (female/male), age group (60-74 years; 75-84 years; 85 or older), marital status (single/have a partner), education (no formal education; 1-4 years; 5-8 years; 9-11; 12 or more years of schooling); per capita household income (quartile); main type of transport (individual motorized; public transport; and active transport - on foot or bicycle); years living in the current address (1-10 years, 11 years or more); and perceived presence of nonresidential neighborhood destinations (Table 1).

Statistical Analysis

Descriptive statistics were calculated for individual and environmental variables. Prior to statistical modelling, Spearman's correlation coefficients were used to compare LUM scores. Multilevel logistic regressions (odds ratios and 95% confidence intervals) were used to analyze the association between walking for transportation (any walking, ≥10 min/week) and environment attributes, adjusting for individual covariates and perceptions of neighborhood destinations, considered here as a potential mediator. The rationale is that, in order for land use mix to exert any influence on respondents’ behaviors, it should first be perceived by them as mixed. In addition, models were adjusted to take into account confounders at the neighborhood level: (1) average slope (%); (2) buffer area (km2); (3) average mean income of the census tract sectors contained within the buffer area. All environmental measures, except richness, were normalized by a z-score. The analyses were performed using IBM SPSS Version 22.0 (Armonk, NY, USA) and Stata IC v.13.0 (StataCorp LP, Texas, USA), considering the design effect (cluster adjustment) and level of significance set at 0.05.

Results

The sample (n=919) consisted mostly of male and young older adults (60 to 74 years old) (see Table 2). A large proportion has lived in the neighborhood for at least 11 years, has a partner and more than half of the participants used private transport (car or motorcycle) as their main mode of transport. A large part of the sample reported walking for transport (70%) and reported the presence of commercial destinations, services, food services and public facilities in the neighborhood. The monthly per capita household income reflected socioeconomic inequalities, with half of the sample reporting an income of less than 2 times the minimum wage in 2013.

Table 2
Descriptive and multilevel logistic regression statistics showing association between the profile of the sample, perception of the environment and walking for transportation in Florianopolis, Brazil. EpiFloripa Ageing Cohort Study, 2013-2014 (n=919)

Most of the participants (70%, n=643) reported an active behavior, defined here as walking to access places for at least 10 continuous minutes in a typical week. However, the proportion of older adults who engaged in any walking for transportation was higher among women, with 60 to 74 years old, higher education (≥ 9 years of schooling) and those reporting the use of public transport. Perceived access to commerce, services and food services increased the chances of walking for transport.

Associations with household income, years living in the neighborhood and the presence of social and health facilities were non-significant (Table 2). Environmental values had great variability in the sample, indicating the presence of variations in the connectivity of the street network, land use mix, and natural aspects of the territory (see Table 3). The average slope of the neighborhoods shows that few of those included in the sample are in sharp inclined terrains, despite the presence of steep areas in the city.

Table 3
Descriptive statistics of objectively measures of built environment in Florianopolis, Brazil. EpiFloripa Ageing Cohort Study, 2013-2014 (n = 919)

Relationships among various measures of land use mix highlight four measures highly interrelated: commercial proportion, non-residential proportion, destination density and entropy (Table 4). Therefore, the increase in the proportion of commercial and non-residential uses may indicate a greater balance (entropy), on average, in the distribution of these uses in the neighborhood. Moreover, the moderate positive relationship between richness, entropy and density of non-residential destinations indicates that an increase in the presence of more land use categories (richness) is associated with the increase in the balance in the distribution of these uses (entropy) and a greater density of destinations in the neighborhood.

Table 4
Correlations among land use measures in Florianopolis, Brazil (n = 919)

The affinities in the representation of LUM between the measures can also explain the strength of the relationships with walking behavior. After considering confounding variables, the interrelated LUM measures had strong and significant relationships with older adults walking for transportation: proportion of commercial uses; proportion of non-residential uses; destination density; and land use balance (Figure 1). The superior results of the measures of commercial proportion (OR = 2.13; CI95%: 1.31–3.47; 500m buffer) and proportion of non-residential uses (OR = 2.04; CI95%: 1.29 –3.22; 500m buffer) indicate that higher occurrences of commercial and non-residential uses increase by 113% and 104% the odds of walking for transport, respectively. Weaker associations were found for measurements computed in 1000m buffers, except for the entropy measure, which had a higher relationship with walking (OR=1.80; 95%CI; 1.35-2.39) in this radius. The odds ratios for built environment and sociodemographic measures, such as slope and neighborhood income, had no significant effect on walking. The relationship with the buffer area indicates that larger polygons, with a well-connected street network, increase the odds of walking for transport (OR=1.38; 95%CI; 1.10-1.73; buffer 1000m).

Figure 1
Plot of adjusted odds ratios and 95% confidence intervals for objectively measured features of the built environment and walking for transportation (≥ 10 min/week). EpiFloripa Ageing Cohort Study, 2013-2014 (n=919). Statistical significance set to p<0.05; CI95%: Confidence interval.

Discussion

The results suggest that aspects of the built environment can influence older adults walking for transportation (WT) even when controlling for individual characteristics and neighborhood-level aspects such as slope and income. Positive associations were found between walking and physical characteristics of the neighborhood. Walking for transport for at least 10min/week was positively associated with being male; having higher education; using public transport; perceived presence of non-residential destinations in a 15-minute walking radius; and living in a neighborhood with street connectivity (network buffer area) and with land use mix (as measured by entropy, proportion of commercial parcels, proportion of nonresidential parcels, and nonresidential density, but not by retail BCR nor richness). On the other hand, age was negatively associated with walking.

The high rate of active participants can be explained by two factors: the high concentration of older people in the downtown area, a region that can be more walkable than other neighborhoods; and the investigated walking domain, which is more prevalent among older adults compared to the leisure domain (Neto, 2019Neto, F. T. de P. (2019). Ambiente Percebido Da Vizinhança E Mudança Na Atividade Física: Estudo Epifloripa Idoso. Dissertação de Mestrado, Pós-Graduação em Educação Física, Universidade Federal de Santa Catarina, Florianópolis, SC.). This reveals the value of WT as an accessible, easily integrated into the daily routine and low-intensity activity, which can play a key role for the health promotion (Van Holle et al., 2014Van Holle, V., Van Cauwenberg, J., Van Dyck, D., Deforche, B., Van de Weghe, N., & De Bourdeaudhuij, I. (2014). Relationship between neighborhood walkability and older adults’ physical activity: Results from the Belgian Environmental Physical Activity Study in Seniors (BEPAS Seniors). International Journal of Behavioral Nutrition and Physical Activity, 11(1), 1–9. https://doi.org/10.1186/s12966-014-0110-3
https://doi.org/10.1186/s12966-014-0110-...
) and maintenance of an active life for older adults in general, and Brazilians in particular (Neto, 2019Neto, F. T. de P. (2019). Ambiente Percebido Da Vizinhança E Mudança Na Atividade Física: Estudo Epifloripa Idoso. Dissertação de Mestrado, Pós-Graduação em Educação Física, Universidade Federal de Santa Catarina, Florianópolis, SC.).

Among the six measures of land use mix (LUM), four showed strong and significant associations with walking, emphasizing that older people living in neighborhoods with a higher commercial proportion in relation to residences; greater non-residential proportion in relation to residences; more non-residential destinations per unit of area; and a higher land use balance (entropy), are more likely to walk for transport. The findings are consistent with previous studies with adults (Michael et al., 2006Michael, Y. L., Beard, T., Choi, D., Farquhar, S., & Carlson, N. (2006). Measuring the influence of built neighborhood environments on walking in older adults. Journal Of Aging And Physical Activity, 14(3), 302–312. https://pdxscholar.library.pdx.edu/commhealth_fac
https://pdxscholar.library.pdx.edu/commh...
; Hoehner et al., 2005Hoehner, C. M., Brennan Ramirez, L. K., Elliott, M. B., Handy, S. L., & Brownson, R. C. (2005). Perceived and objective environmental measures and physical activity among urban adults. American Journal of Preventive Medicine, 28(2), 105–116. https://doi.org/10.1016/J.AMEPRE.2004.10.023
https://doi.org/10.1016/J.AMEPRE.2004.10...
; Krizek & Johnson, 2006Krizek, K. J., & Johnson, P. J. (2006). Proximity to trails and retail: Effects on urban cycling and walking. Journal of the American Planning Association, 72(1), 33–42. https://doi.org/10.1080/01944360608976722
https://doi.org/10.1080/0194436060897672...
; Frank et al., 2007Frank, L. D., Kerr, J., Chapman, J., & Sallis, J. (2007). Urban form relationships with walk trip frequency and distance among youth. American Journal of Health Promotion, 21(4 SUPPL.), 305–311.; Hino et al., 2014Hino, A. A. F., Reis, R. S., Sarmiento, O. L., Parra, D. C., & Brownson, R. C. (2014). Built environment and physical activity for transportation in adults from Curitiba, Brazil. Journal of Urban Health, 91(3), 446–462. https://doi.org/10.1007/s11524-013-9831-x
https://doi.org/10.1007/s11524-013-9831-...
; Hirsch et al., 2016Hirsch, J. A., Winters, M., Ashe, M. C., Clarke, P. J., & McKay, H. A. (2016). Destinations That Older Adults Experience Within Their GPS Activity Spaces: Relation to Objectively Measured Physical Activity. Environment and Behavior, 48(1), 55–77. https://doi.org/10.1177/0013916515607312
https://doi.org/10.1177/0013916515607312...
) and older adults (Michael et al., 2006Michael, Y. L., Beard, T., Choi, D., Farquhar, S., & Carlson, N. (2006). Measuring the influence of built neighborhood environments on walking in older adults. Journal Of Aging And Physical Activity, 14(3), 302–312. https://pdxscholar.library.pdx.edu/commhealth_fac
https://pdxscholar.library.pdx.edu/commh...
; Van Cauwenberg et al., 2012Van Cauwenberg, J., Van Holle, V., Simons, D., Deridder, R., Clarys, P., Goubert, L., Nasar, J., Salmon, J., De Bourdeaudhuij, I., & Deforche, B. (2012). Environmental factors influencing older adults’ walking for transportation: a study using walk-along interviews. International Journal of Behavioral Nutrition and Physical Activity, 9(1), 85. https://doi.org/10.1186/1479-5868-9-85
https://doi.org/10.1186/1479-5868-9-85...
; Cerin et al., 2013Cerin, E., Lee, K. yiu, Barnett, A., Sit, C. H. P., Cheung, M. chin, Chan, W. man, & Johnston, J. M. (2013). Walking for transportation in Hong Kong Chinese urban elders: A cross-sectional study on what destinations matter and when. International Journal of Behavioral Nutrition and Physical Activity, 10(1), 78. https://doi.org/10.1186/1479-5868-10-78
https://doi.org/10.1186/1479-5868-10-78...
; Cerin, Mitáš et al., 2017Cerin, E., Mitáš, J., Cain, K. L., Conway, T. L., Adams, M. A., Schofield, G., Sarmiento, O. L., Reis, R. S., Schipperijn, J., Davey, R., Salvo, D., Orzanco-Garralda, R., Macfarlane, D. J., De Bourdeaudhuij, I., Owen, N., Sallis, J. F., & Van Dyck, D. (2017). Do associations between objectively-assessed physical activity and neighbourhood environment attributes vary by time of the day and day of the week? IPEN adult study. International Journal of Behavioral Nutrition and Physical Activity, 14(1), 1–16. https://doi.org/10.1186/s12966-017-0493-z
https://doi.org/10.1186/s12966-017-0493-...
; Yun, 2019Yun, H. Y. (2019). Environmental factors associated with older adult’s walking behaviors: A systematic review of quantitative studies. Sustainability (Switzerland), 11(12). https://doi.org/10.3390/su10023253
https://doi.org/10.3390/su10023253...
). In this sense, access to non-residential destinations in the neighborhood can be a key environmental correlate.

Relationships among LUM measures indicate that these measures associated with walking are also highly interrelated. Thus, although the calculation of the entropy index does not show the contribution of separate land use categories to diversity (Brown et al., 2009Brown, B. B., Yamada, I., Smith, K. R., Zick, C. D., Kowaleski-Jones, L., & Fan, J. X. (2009). Mixed land use and walkability: Variations in land use measures and relationships with BMI, overweight, and obesity. Health and Place, 15(4), 1130–1141. https://doi.org/10.1016/j.healthplace.2009.06.008
https://doi.org/10.1016/j.healthplace.20...
), this study indicates that higher entropy scores can be an effective approximation to the presence of more mixed uses in the studied neighborhoods. However, the superior performance of alternative measures suggests that it is the presence of different land uses that can more strongly increase the chances of an older adult walking as a means of locomotion, not the balance of land use distribution based on entropy scores.

Our results also indicate that environmental variables associated with walking vary according to the neighborhood definition, emphasizing that 500m (10 min.) buffers can more effectively represent the neighborhood area of this age group. On the other hand, the entropy index had weaker associations with WT in the small neighborhood scale. Although the 1000m buffer associations were generally weaker in relation to the other measures, with the entropy index the strength of the relationships was greater in buffers of 1000 meters. The results are consistent with previous publications that found a greater entropy effect on travel mode choice on scores calculated at a relatively higher aggregated level (Zhang & Kukadia, 2005Zhang, M., & Kukadia, N. (2005). Metrics of Urban Form and the Modifiable Areal Unit Problem. Transportation Research Record: Journal of the Transportation Research Board, 1902(1), 71–79. https://doi.org/10.1177/0361198105190200109
https://doi.org/10.1177/0361198105190200...
). Other previous research highlighted different results (Forsyth et al., 2008Forsyth, A., Hearst, M., Oakes, J. M., & Schmitz, K. H. (2008). Design and destinations: Factors influencing walking and total physical activity. Urban Studies, 45(9), 1973–1996. https://doi.org/10.1177/0042098008093386
https://doi.org/10.1177/0042098008093386...
; Brownson et al., 2009Brownson, R. C., Hoehner, C. M., Day, K., Forsyth, A., & Sallis, J. F. (2009). Measuring the Built Environment for Physical Activity. State of the Science. American Journal of Preventive Medicine, 36(4 SUPPL.), 99–123. https://doi.org/10.1016/j.amepre.2009.01.005
https://doi.org/10.1016/j.amepre.2009.01...
; Lu et al., 2018Lu, Y., Chen, L., Yang, Y., & Gou, Z. (2018). The association of built environment and physical activity in older adults: Using a citywide public housing scheme to reduce residential self-selection bias. International Journal of Environmental Research and Public Health, 15(9), 1–13. https://doi.org/10.3390/ijerph15091973
https://doi.org/10.3390/ijerph15091973...
; Wei et al., 2016Wei, Y. D., Xiao, W., Wen, M., & Wei, R. (2016). Walkability, land use and physical activity. Sustainability (Switzerland), 8(1), 1–16. https://doi.org/10.3390/su8010065
https://doi.org/10.3390/su8010065...
). Divergences may be due to methodological discrepancies (such as land use categories included in the index) or geographic variations in the study area and participating populations (McConville et al., 2011McConville, M. E., Rodríguez, D. A., Clifton, K., Cho, G., & Fleischhacker, S. (2011). Disaggregate land uses and walking. American Journal of Preventive Medicine, 40(1), 25–32. https://doi.org/10.1016/j.amepre.2010.09.023
https://doi.org/10.1016/j.amepre.2010.09...
).

It is noteworthy that the simplification of land use categories to a count of richness reduced the possibility of contribution of different uses to walking and weakened the results. However, the moderately positive relationship of richness values with entropy and destination density values indicates that the increased richness can explain: a) the increase in balance in the distribution of uses (entropy); and b) a greater density of destinations in the studied neighborhoods. Likewise, the measure of retail BCR was not associated with walking, differing from results observed in North American cities (Wood et al., 2010Wood, L., Frank, L. D., & Giles-Corti, B. (2010). Sense of community and its relationship with walking and neighborhood design. Social Science and Medicine, 70(9), 1381–1390. https://doi.org/10.1016/j.socscimed.2010.01.021
https://doi.org/10.1016/j.socscimed.2010...
; Wei et al., 2016Wei, Y. D., Xiao, W., Wen, M., & Wei, R. (2016). Walkability, land use and physical activity. Sustainability (Switzerland), 8(1), 1–16. https://doi.org/10.3390/su8010065
https://doi.org/10.3390/su8010065...
). Although it is argued that a higher retail BCR can mean more choice of destinations within walking distance, no large retail activities (e.g. shopping malls), less parking space and more pedestrian comfort (Leslie et al., 2007Leslie, E., Coffee, N., Frank, L., Owen, N., Bauman, A., & Hugo, G. (2007). Walkability of local communities: Using geographic information systems to objectively assess relevant environmental attributes. Health and Place, 13(1), 111–122. https://doi.org/10.1016/j.healthplace.2005.11.001
https://doi.org/10.1016/j.healthplace.20...
; Wei et al., 2016Wei, Y. D., Xiao, W., Wen, M., & Wei, R. (2016). Walkability, land use and physical activity. Sustainability (Switzerland), 8(1), 1–16. https://doi.org/10.3390/su8010065
https://doi.org/10.3390/su8010065...
), the results that found association with walking for transportation were not corroborated in the Brazilian context. Discrepancies indicate limitations and reinforce the need to apply alternative measures, appropriate to the urban context under investigation.

Having nearby destinations and mixed land use refers to only one of the three components of walkability: land use mix. Another attribute explored by walkability is design, here represented by the connectivity. The strong association between walking and the buffer area indicates that walking can be facilitated by optimizing the connectivity of the street network, that result in larger area neighborhoods. In other words, urban grids that maximize the reach through the network for a given radius tend to facilitate the access to more potential destinations and thus promote walking. A previous study with the first wave of EpiFloripa Aging cohort study reinforces this understanding (Giehl et al., 2016Giehl, M. W. C., Hallal, P. C., Corseuil, C. W., Schneider, I. J. C., & D’Orsi, E. (2016). Built Environment and Walking Behavior among Brazilian Older Adults: A Population-Based Study. Journal of Physical Activity and Health, 13(6), 617–624. https://doi.org/10.1123/jpah.2015-0355
https://doi.org/10.1123/jpah.2015-0355...
).

This study has some limitations. First, the EpiFloripa Aging cohort study was not developed to investigate specific effects of the built environment on physical activity (PA), even though the database was an essential source of information for this work. Self-reported measure of WT may be subject to recall bias and IPAQ only capture activities of at least 10 min, which can be more than the usual commuting of some older adults. Pre-existing environmental data may have risks of inaccuracy in the degree to which they reflect reality. Further studies can explore monitored WT data and its variation over time by longitudinal designs. In addition, further research exploring the influence of qualified and safe amenities for the utilitarian walk is needed (e.g. the presence or absence of sidewalks and lighting, traffic volume and maintenance of places) (Hirsch et al., 2016Hirsch, J. A., Winters, M., Ashe, M. C., Clarke, P. J., & McKay, H. A. (2016). Destinations That Older Adults Experience Within Their GPS Activity Spaces: Relation to Objectively Measured Physical Activity. Environment and Behavior, 48(1), 55–77. https://doi.org/10.1177/0013916515607312
https://doi.org/10.1177/0013916515607312...
; Barnett et al., 2017Barnett, D. W., Barnett, A., Nathan, A., Van Cauwenberg, J., & Cerin, E. (2017). Built environmental correlates of older adults’ total physical activity and walking: A systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity, 14(103). https://doi.org/10.1186/s12966-017-0558-z
https://doi.org/10.1186/s12966-017-0558-...
; Yun, 2019Yun, H. Y. (2019). Environmental factors associated with older adult’s walking behaviors: A systematic review of quantitative studies. Sustainability (Switzerland), 11(12). https://doi.org/10.3390/su10023253
https://doi.org/10.3390/su10023253...
). Despite the limitations, our results show the significance of the associations and the impact of mixed land use in the social and health context.

Conclusion

Our findings indicate that urban planning and design policies that promote neighborhoods with access to non-residential destinations - such as markets, grocery stores, restaurants, retail stores and bakeries - may lead to more engagement in walking for transport, reducing motorized trips and promoting healthy behaviors among older adults. This study also identified that the less active groups are the oldest (above 85 years), women and people with lower education levels, indicating the need for urban and public health policies more adapted to these groups.

Studying physical activity environmental correlates means understanding ways to create healthier and sustainable communities, preparing cities for the future demographic trend. Directions for future research include analyses that evaluates the relationship of specific destinations to objectively measured walking or involve GPS-based spatial units of analysis. Longitudinal designs and verifications on the influence of socioeconomic aspects on the relationship between built environment and walking can be included.

Acknowledgements

Catharina Cavasin Salvador had a fellowship from CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil - Code 001. The EpiFloripa Elderly cohort study (2013/14) was funded by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) (nº 526.126/2013) and developed by the Federal University of Santa Catarina.

Data availability statement

The dataset that supports the results of this paper is available at SciELO Data and can be accessed via https://doi.org/10.48331/scielodata.C8LYSR

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Edited by

Editor responsável: Geisa Bugs

Publication Dates

  • Publication in this collection
    02 Feb 2024
  • Date of issue
    2024

History

  • Received
    10 Oct 2022
  • Accepted
    02 May 2023
Pontifícia Universidade Católica do Paraná Rua Imaculada Conceição, 1155. Prédio da Administração - 6°andar, 80215-901 - Curitiba - PR, 55 41 3271-1701 - Curitiba - PR - Brazil
E-mail: urbe@pucpr.br