Elsevier

Health & Place

Volume 63, May 2020, 102337
Health & Place

Correlates of walking among disadvantaged groups: A systematic review

https://doi.org/10.1016/j.healthplace.2020.102337Get rights and content

Highlights

  • The factors influencing the different types of walking behavior vary.

  • Interventions should focus on improving self-rated health, social ties, aesthetics, walkability and individual safety.

  • Future studies need to focus on psychological, social, cultural, behavioral attributes and skills.

Abstract

Socioeconomically disadvantaged groups are less likely to be physically active. Walking is important to public health, therefore understanding correlates of walking will inform the development of targeted interventions. The aim of this systematic review was to examine the correlates of walking among socioeconomically disadvantaged adults. PubMed/MEDLINE and Scopus were searched up to February 2020 and titles/abstracts and full-texts were screened against eligibility criteria. Methodological quality was assessed. Correlates were synthesized when two or more comparisons were available. 35 studies were selected for synthesis. 21 examined overall walking, 16 examined leisure-time walking and 9 examined walking for transport (8 examined two or more types of walking). Employment status, home ownership, self-rated health, density or number of social ties, perceived neighborhood aesthetics, perceived walkability and perceived individual safety were positively associated with overall walking. Social support for physical activity from friends and family and perceived individual safety were positively associated with leisure-time walking. Objective walkability, perceived walkability and perceived individual safety were positively associated with walking for transport. Most studies were cross-sectional, did not report response rates and used a validated measure of physical activity. Strategies to improve self-rated health, social ties, neighborhood aesthetics, walkability and perceptions of individual safety should be the focus of interventions that aim to improve walking among socioeconomically disadvantaged groups. Recommendations for future studies include the need to focus on leisure-time walking and walking for transport; the correlates of walking in males; prospective longitudinal designs; psychological, cognitive and emotional variables; and social, behavioral attributes and skills.

Introduction

Physical activity provides a range of health benefits (Allender and Rayner, 2007; Mueller et al., 2015; Powell et al., 2011; Reiner et al., 2013; Warburton and Bredin, 2017). There is strong evidence that physical activity can prevent and reduce the risk of several non-communicable diseases, including coronary heart disease, stroke, breast and colon cancer, type 2 diabetes and depression (Reiner et al., 2013; Berrington de Gonzalez et al., 2010; Physical Activity Guidelines Advisory Committee, 2008; Kokkinos, 2012; Vogel et al., 2009; Warburton et al., 2006). Moderate-intensity physical activity equivalent to brisk walking confers enough benefit to prevent a plethora of poor health outcomes (Pate et al., 1995). Despite these benefits, over 40% of adults in developed countries do not meet the recommended levels of physical activity (Kohl et al., 2012).

It has been consistently found that residents from socioeconomically disadvantaged groups are less likely to be physically active and are therefore disproportionately affected by adverse health outcomes (Ball, 2015; Beenackers et al., 2012; Gidlow et al., 2006; Lee et al., 2007; Loh et al., 2016; Turrell et al., 2010). Therefore, improving physical activity levels among socioeconomically disadvantaged groups is of public health significance (Ball, 2015; Australian Institute of Health and Welfare, 2014; Carey et al., 2015; Frieden, 2014). Walking has been defined as the most natural form of movement around our environment (Morris and Hardman, 1997), and is beneficial for health (Lee and Buchner, 2008), therefore Kelly et al. (2017), suggest that the accumulated evidence for walking points to further promotion for all. In 2015, the United States Department of Health and Human Services (USDHHS) (United States Department of Health and Human Services, 2015) released ‘Step It Up! The Surgeon General's Call to Action to Promote Walking and Walkable Communities' in recognition of walking as an important way to promote physical activity.

Globally, walking is the most popular type of physical activity for adults (Kelly et al., 2017; T-aLee et al., 2013; National Institute for Health and Care Excellence, 2012). In a recent systematic review and meta-analysis, Hulteen et al. (2017), reported that walking was the most popular activity among the Americas (18.9%), East Mediterranean (15%), Southeast Asia (39.3%) and Western Pacific (41.8%) regions. In addition, the USDHHS (United States Department of Health and Human Services, 2015) reported that 62% of adults reported walking 10 minutes or more in the past week for transportation or leisure. Walking participation can be separated into those for leisure and recreation purposes, and those to get to and from places (transport) (Lachowycz and Jones, 2014). Both leisure-time walking and walking for transport contribute towards meeting physical activity guidelines (Ainsworth et al., 2011; Berrigan et al., 2006). Walking is a popular form of physical activity because it is an accessible (Kelly et al., 2017), convenient and free way to explore the world regardless of sex, ethnic group, age, education or income level (Lee and Buchner, 2008; Fox et al., 2012). There is no need for specialized skills, facilities or expensive equipment and clothing (Chudyk et al., 2017). Consequently, interventions to increase walking in socioeconomically disadvantaged groups is one way to improve participation in physical activity and reduce disparities in health related to a lack of physical activity.

Identifying factors that are associated with participation in physical activity is typically referred to in the literature as the study of correlates (statistical associations) (Bauman et al., 2002; Biddle et al., 2004). Distinguishing and understanding correlates of walking (overall, leisure and transport) in socioeconomically disadvantaged groups is needed to inform the development of targeted interventions for this population group (Kelly et al., 2017; Koohsari et al., 2017a; Van Dyck et al., 2013). Socioecological approaches to physical activity posit that individual characteristics, the social and physical environment and policies influence participation, and are interrelated and embedded in a complex system (Gubbels et al., 2014; Sallis et al., 2006). Identifying the factors that are associated with walking will help to inform public health efforts to support and promote walking. In addition, understanding the extent to which the targeting of intervention strategies is required for different socioeconomic groups has been highlighted as a major gap that needs to be addressed (Blamey and Mutrie, 2004).

To the authors’ knowledge, no reviews have examined the correlates of walking in socioeconomically disadvantaged groups. The aims of this systematic review are to examine, among adults from socioeconomically disadvantaged groups, the correlates of (i) overall walking, (ii) leisure-time walking, and (iii) walking for transport. The findings of this review will assist in the development of targeted interventions and will provide recommendations for future research.

Section snippets

Data sources

To identify studies, PubMed/MEDLINE and Scopus were searched up to February 2020 with no date limitation. Groups of thesaurus terms and free terms were searched for physical activity (“physical* activ*“, walk*, exercise, lifestyle, “life style”, “health behavio*"), correlates (correlate, determinant, mediator, moderator, predictor, relationships, associations, barriers, facilitators); socioeconomic disadvantage (“low SES”, “low* socio*“, “low* income”, disadvantaged, deprived, underserved,

Characteristics of included studies

In total, 1727 titles and abstracts were screened; 1578 were removed by title/abstract, and 149 full texts were reviewed, 35 of which were selected for synthesis (see Fig. 1 PRISMA flowchart).

Most eligible studies included correlates of overall walking (n = 21), 16 included analyses on leisure-time walking and 9 on walking for transport (8 examined two or more types of walking). We present the study characteristics, quality assessment and findings of these analyses separately (noting that some

Summary

We found evidence for consistent associations for 10/31 factors examined for overall walking, 2/15 factors for leisure-time walking and 4/11 factors for walking for transport. Age, BMI and weight status, and perceived individual safety, were the most commonly examined factors in relation to overall walking, whereas objective walkability was the most commonly examined factor for leisure-time walking and walking for transport. Our findings showed that the factors influencing different types of

Conclusions

The findings of our review suggest that future intervention studies should incorporate strategies to improve self-rated health, social ties, neighbourhood aesthetics, walkability and perceptions of individual safety. We also identified that older adults, those who are overweight or obese, and those not in the workforce as priority groups for intervention studies or whose needs should be considered when designing interventions. In socioeconomically disadvantaged population groups, more studies

Declaration of competing interest

The authors declare no conflicts of interest.

References (119)

  • P. Ekkekakis et al.

    Walking is popular among adults but is it pleasant? A framework for clarifying the link between walking and affect as illustrated in two studies

    Psychol. Sport Exerc.

    (2008)
  • S. Foster et al.

    The built environment, neighborhood crime and constrained physical activity: an exploration of inconsistent findings

    Prev. Med.

    (2008)
  • J.S. Gubbels et al.

    The impact of greenery on physical activity and mental health of adolescent and adult residents of deprived neighborhoods: a longitudinal study

    Health Place

    (2016)
  • R.M. Hulteen et al.

    Global participation in sport and leisure-time physical activities: a systematic review and meta-analysis

    Prev. Med.

    (2017)
  • S. Inoue et al.

    Sociodemographic determinants of pedometer-determined physical activity among Japanese adults

    Am. J. Prev. Med.

    (2011)
  • H.W. Kohl et al.

    The pandemic of physical inactivity: global action for public health

    Lancet

    (2012)
  • K. Lachowycz et al.

    Does walking explain associations between access to greenspace and lower mortality?

    Soc. Sci. Med.

    (2014)
  • V.H. Loh et al.

    Neighborhood disadvantage, individual-level socioeconomic position and physical function: a cross-sectional multilevel analysis

    Prev. Med.

    (2016)
  • P. Mason et al.

    Neighbourhood walking and regeneration in deprived communities

    Health Place

    (2011)
  • P. Mason et al.

    "Safe Going": the influence of crime rates and perceived crime and safety on walking in deprived neighbourhoods

    Soc. Sci. Med.

    (2013)
  • G.R. McCormack et al.

    The relationship between cluster-analysis derived walkability and local recreational and transportation walking among Canadian adults

    Health Place

    (2012)
  • N. Mueller et al.

    Health impact assessment of active transportation: a systematic review

    Prev. Med.

    (2015)
  • E.M. Murtagh et al.

    The effect of walking on risk factors for cardiovascular disease: an updated systematic review and meta-analysis of randomised control trials

    Prev. Med.

    (2015)
  • E. Rees-Punia et al.

    Crime, perceived safety, and physical activity: a meta-analysis

    Prev. Med.

    (2018)
  • J.F. Sallis et al.

    Neighborhood environments and physical activity among adults in 11 countries

    Am. J. Prev. Med.

    (2009)
  • J.F. Sallis et al.

    Neighborhood built environment and income: examining multiple health outcomes

    Soc. Sci. Med.

    (2009)
  • A. Sawyer et al.

    Supportive environments for physical activity in deprived communities in the United Kingdom: a qualitative study using photo elicitation

    Soc. Sci. Med.

    (2018)
  • B. Sehatzadeh et al.

    Walking frequency, cars, dogs, and the built environment

    Transport. Res. Part A Policy Pract.

    (2011)
  • R.C. Shelton et al.

    Racial discrimination and physical activity among low-Income-housing residents

    Am. J. Prev. Med.

    (2009)
  • B.E. Ainsworth et al.

    2011 Compendium of Physical Activities: a second update of codes and MET values

    Med. Sci. Sports Exerc.

    (2011)
  • S. Allender et al.

    The burden of overweight and obesity-related ill health in the UK

    Obes. Rev.

    (2007)
  • Australian Institute of Health and Welfare

    Australia's Health 2014. Canberra, Australia: AIHW

    (2014)
  • K. Ball

    Traversing myths and mountains: addressing socioeconomic inequities in the promotion of nutrition and physical activity behaviours

    Int. J. Behav. Nutr. Phys. Activ.

    (2015)
  • K. Ball et al.

    Is healthy behavior contagious: associations of social norms with physical activity and healthy eating

    Int. J. Behav. Nutr. Phys. Activ.

    (2010)
  • A.E. Bauman et al.

    Environmental Correlates of Physical Activity and Walking in Adults and Children: a Review of Reviews

    (2007)
  • M.A. Beenackers et al.

    Socioeconomic inequalities in occupational, leisure-time, and transport related physical activity among European adults: a systematic review

    Int. J. Behav. Nutr. Phys. Activ.

    (2012)
  • G.G. Bennett et al.

    Pedometer-determined physical activity among multiethnic low-income housing residents

    Med. Sci. Sports Exerc.

    (2006)
  • G.G. Bennett et al.

    Safe to walk? Neighborhood safety and physical activity among public housing residents

    PLoS Med.

    (2007)
  • A. Berrington de Gonzalez et al.

    Body-mass index and mortality among 1.46 million white adults

    N. Engl. J. Med.

    (2010)
  • L. Bherer et al.

    A review of the effects of physical activity and exercise on cognitive and brain functions in older adults

    J Aging Res.

    (2013)
  • S.J. Biddle et al.

    Health-enhancing physical activity and sedentary behaviour in children and adolescents

    J. Sports Sci.

    (2004)
  • A. Blamey et al.

    Changing the individual to promote health-enhancing physical activity: the difficulties of producing evidence and translating it into practice

    J. Sports Sci.

    (2004)
  • M. Booth

    Assessment of physical activity: an international perspective

    Res. Q. Exerc. Sport

    (2000)
  • N.L. Bracy et al.

    Is the relationship between the built environment and physical activity moderated by perceptions of crime and safety?

    Int. J. Behav. Nutr. Phys. Activ.

    (2014)
  • B.B. Brown et al.

    Walkable route perceptions and physical features: converging evidence for en route walking experiences

    Environ. Behav.

    (2007)
  • G. Carey et al.

    Towards health equity: a framework for the application of proportionate universalism

    Int. J. Equity Health

    (2015)
  • A.M. Chudyk et al.

    Neighborhood walkability, physical activity, and walking for transportation: a cross-sectional study of older adults living on low income

    BMC Geriatr.

    (2017)
  • C.L. Craig et al.

    International physical activity questionnaire: 12-country reliability and validity

    Med. Sci. Sports Exerc.

    (2003)
  • M. Craike et al.

    Interventions to improve physical activity among socioeconomically disadvantaged groups: an umbrella review

    Int. J. Behav. Nutr. Phys. Activ.

    (2018)
  • D. Van Dyck et al.

    Environmental perceptions as mediators of the relationship between the objective built environment and walking among socio-economically disadvantaged women

    Int. J. Behav. Nutr. Phys. Activ.

    (2013)
  • Cited by (21)

    • How does low income affect older people's travel practices? Findings of a qualitative case study on the links between financial poverty, mobility and social participation

      2023, Travel Behaviour and Society
      Citation Excerpt :

      Among those aged over 65, only 4 % of men and 8 % of women at risk of poverty, as opposed to 8 % of men and 12 % of women with higher incomes, own a public transport season pass (Giesel & Köhler, 2015). Cycling and walking are generally considered to be cost-effective transport modes (Chudyk et al., 2017a; Chudyk et al., 2017b; Handy et al., 2014; Hilland et al., 2020; Sarrica et al., 2019). But, as Rozynek et al. (2022) argue, the link between poor financial resources and cycling is not clear in previous research.

    • Neighbourhood correlates of average population walking: using aggregated, anonymised mobile phone data to identify where people walk

      2022, Health and Place
      Citation Excerpt :

      Yet, studies show that less than a third of the adult population engage in adequate activity levels to meet minimum recommendations for health promotion and disease prevention (Guthold et al., 2018; Mielke et al., 2018). Globally, walking is the most popular form of physical activity for adults (Hilland et al., 2020). Walking is popular because it is cost-free, accessible and convenient (Kelly et al., 2017).

    • The influence of limited financial resources on daily travel practices. A case study of low-income households with children in the Hanover Region (Germany)

      2022, Journal of Transport Geography
      Citation Excerpt :

      Studies even show that when individuals cannot afford public transport tickets, illegal strategies, such as fare evasion, are practised (Daubitz, 2016; González et al., 2019; Perrotta, 2017; Schwerdtfeger., 2019). Non-motorised transport modes, such as cycling and walking, are considered cost-effective (Chandra et al., 2017; Grieco, 1995; Handy et al., 2014; Hilland et al., 2020; Sarrica et al., 2019). But the link between cycling and income appears to be complex and ambiguous in detail.

    View all citing articles on Scopus
    View full text