Cross-sectional associations between neighbourhood walkability and objective physical activity levels in identical twins

Abstract

Objectives: Physical activity is a cornerstone of chronic disease prevention and treatment, yet most US adults do not perform levels recommended for health. The neighborhood-built environment (BE) may support or hinder physical activity levels. This study investigated whether identical twins who reside in more walkable BEs have greater activity levels than twins who reside in less walkable BEs (between-twin analysis), and whether associations remain significant when controlling for genetic and shared environmental factors (within-twin analysis).

Design: A cross-sectional study.

Setting: The Puget Sound region around Seattle, Washington, USA.

Participants: The sample consisted of 112 identical twin pairs who completed an in-person assessment and 2-week at-home measurement protocol using a global positioning system (GPS)monitor and accelerometer.

Exposure: The walkability of each participants' place of residence was calculated using three BE dimensions (intersection density, population density and destination accessibility). For each variable, z scores were calculated and summed to produce the final walkability score.

Outcomes: Objectively measured bouts of walking and moderate-to-vigorous physical activity (MVPA), expressed as minutes per week.

Results: Walkability was associated with walking bouts (but not MVPA) within the neighbourhood, both between (b=0.58, SE=0.13, p<0.001) and within pairs (b=0.61, SE=0.18, p=0.001). For a pair with a 2-unit difference in walkability, the twin in a more walkable neighbourhood is likely to walk approximately 16 min per week more than the co-twin who lives in a less walkable neighbourhood.

Conclusions: This study provides robust evidence of an association between walkability and objective walking bouts. Improvements to the neighbourhood BE could potentially lead to increased activity levels in communities throughout the USA.

Keywords: EPIDEMIOLOGY; PREVENTIVE MEDICINE; PUBLIC HEALTH.