Correlates of walking among disadvantaged groups: A systematic review
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.
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