Relationship between Objectively Measured Walkability and Exercise Walking among Adults with Diabetes

Little is known about the relationship between objectively measured walkability and walking for exercise among adults with diabetes. Information regarding walking behavior of adults with diabetes residing in 3 Upstate New York counties was collected through an interview survey. Walkability measures were collected through an environmental audit of a sample of street segments. Overall walkability and 4 subgroup measures of walkability were aggregated at the ZIP level. Multivariate logistic regression was used for analysis. Study participants were 61.0% female, 56.7% non-Hispanic White, and 35.1% African-American, with a mean age of 62.0 years. 108 participants (51.9%) walked for exercise on community streets, and 62 (29.8%) met the expert-recommended level of walking for ≥150 minutes/week. After adjustment for age, gender, race/ethnicity, education, BMI, physical impairment, and social support for exercise, walking any minutes/week was associated with traffic safety (OR 1.34, 95% CI 1.15–1.65). Walking ≥150 minutes/week was associated with overall walkability of the community (2.65, 1.22, and 5.74), as well as sidewalks (1.73, 1.12–2.67), street amenity (2.04, 1.12–3.71), and traffic safety (1.92, 1.02–3.72). This study suggests that walkability of the community should be an integral part of the socioecologic approach to increase physical activity among adults with diabetes. 1. Introduction Walking is a low-impact, moderate-intensity aerobic physical activity that requires little equipment or training. It is the most popular physical activity among Americans of various sociodemographic backgrounds and physical abilities, including individuals with diabetes [1–4]. Research has found that walking has several health benefits to adults with diabetes. Meta-analyses indicate that routine walking and other types of moderate aerobic exercise can improve glycemic control as indicated by decreased HbA1c [5, 6] and lower systolic blood pressure, triglycerides, and waist circumference [7]. Routine walking is also independently associated with lower levels of circulating proinflammatory markers [8], significant reduction of cardiovascular events [9], and lower cardiovascular mortality and all-cause mortality in adults with diabetes [10, 11]. Most Americans use community streets for leisure time walking [12]. Walking on community streets is convenient and inexpensive and can be sustainable. When planning to promote community walking, however, one should consider environmental barriers and enablers for walking in the community. A volume of literature indicates that