How the built environment affects change in older people's physical activity: A mixed- methods approach using longitudinal health survey data in urban China

- Sedentary people in lively apartments were more likely to initiate physical activity.
- Physically active neighbors helped regulate/maintain individual physical activity.
- Living close to functional spaces helped older people maintain physical activity.
- Improving residential form and access to services can promote physical activity.

Although the general population in China is physically active, only 45% of older adults meet the World Health Organization's recommendation for weekly moderate-to-vigorous exercise, to achieve health benefits. This percentage is even lower (9.8%) in urban China. It is, therefore, important to understand the pathways by which physical activity behaviors are impacted by the built environment. This study utilized a mixed methods approach-interviews (n = 42) and longitudinal (2010-2015) health survey data (n = 3094) for older people residing in three neighborhoods in Huainan, a mid-sized city in Anhui Province, central eastern China. First, a content analysis of interview data was used to identify individual and built environment factors (motivators and barriers) that impacted physical activity within older people's activity spaces. Second, a multilevel path analysis was conducted using the health survey data to demonstrate the pathways by which these motivators and barriers contributed to the initiation, regulation, and maintenance of physical activity. This study found (a) that the liveliness of an apartment building and its proximity to functional spaces (fast-food stores, farmer's markets, supermarkets, pharmacies, schools, hospitals, PA facilities and natural and man-made water bodies) were important factors in attracting sedentary older people to initiate physical activity; (b) the social networks of apartment neighbors helped to initiate, regulate, and maintain physical activity; and housing closeness to functional spaces was important in maintaining physical activity, particularly for those older people with chronic diseases. To increase older people's overall physical activity, future interventions should focus on residential form and access to functional spaces, prior to investing in large-scale urban design interventions.