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Built Environment Attributes and

Walking Patterns Among the


Elderly Population in Bogot
Luis F. Gmez, MD, MPH, Diana C. Parra, MPH, David Buchner, MD, MPH,
Ross C. Brownson, PhD, Olga L. Sarmiento, MD, MPH, PhD, Jos D. Pinzn, Arq,
Mauricio Ardila, MA, Jos Moreno, MS, Mauricio Serrato, MD, Felipe Lobelo, MD, PhD

Background: There is increasing evidence that the built environment has an influence on physical
activity; however, little is known about this relationship in developing countries.

Purpose: This study examined the associations between attributes of the built environment and
walking patterns among the elderly.

Methods: A multilevel cross-sectional study was conducted in 2007. Fifty neighborhoods were selected and
1966 participants aged 60 years were surveyed. Objective built environment measures were obtained in a
buffer of 500 m using GIS. Environmental perceptions were assessed via questionnaire.

Results: People who lived in areas with middle park area (4.53%7.98% of land) were more likely to
walk for at least 60 minutes during a usual week (prevalence OR [POR]1.42, 95% CI1.02, 1.98).
Those who lived in areas with the highest connectivity index (1.811.99) were less likely to report
walking for at least 60 minutes (POR0.64, 95% CI0.44, 0.93). Participants who reported feeling
safe or very safe from traffc were more likely to report walking for at least 60 minutes (POR1.50,
95% CI1.11, 2.03). The presence of Ciclova (recreational program) was marginally associated with
having walked at least 150 minutes in a usual week (POR1.29, 95% CI0.97, 1.73).

Conclusions: This study showed that certain built and perceived environment characteristics were
associated with walking among older adults living in Bogot. Further studies should be conducted to
better understand the potential influence of the built environment on physical activity among the
elderly population in the context of Latin American cities.
(Am J Prev Med 2010;38(6):592599) 2010 American Journal of Preventive Medicine

Introduction
here is strong evidence1 that regular physical activity

From the Division de Salud, Fundacin FES Social (Gomez, Parra,


T provides substantial health benefts to older adults.
Physical activity among elderly people has been pos-
itively associated2,3 with prevention of chronic diseases, dis-
Moreno), Prevention Research Center in St. Louis (Parra, Brownson),
ability, and bone fractures. In addition, physical activity re-
George Warren Brown School of Social Work, Washington University in duces the risk of cognitive decline and depression
St. Louis; Department of Surgery and Alvin J. Siteman Cancer Center symptoms, as it improves independent living.4
(Brownson), Washington University School of Medicine, Washington Uni-
versity in St. Louis, St. Louis, Missouri; The Department of Kinesiology and
Walking has been recognized5 as an important form of
Community Health (Buchner), University of Illinois, Urbana-Champaign, physical activity that can be easily incorporated into daily
Illinois; Department of Social Medicine (Sarmiento), School of Medicine, life. In addition, walking is an activity that does not re-
Universidad de los Andes; Centro de Estudios Urbanos (Pinzn, Ardila),
Corporacin de Universidades del Centro de la Ciudad; Universidad Na- quire special equipment or facilities, and has a low risk of
cional de Colombia (Serrato), Bogot, Colombia; CDC (Lobelo), Offce of injury.6 9 Despite these benefts, the prevalence of inac-
Workforce and Career Development and Division of Nutrition, Physical tivity is relatively high in Latin America. For example, in
Activity and Obesity, Physical Activity and Health Branch, Atlanta, Georgia
Address correspondence to: Luis F. Gmez, MD, MPH, Fundacin FES Bogot, only 45% of the adult population meets the min-
Social, Divisin de salud, Carrera 7 # 73-55, Ofcina 1202, Bogot, Colom- imum recommended levels of physical activity.10 Older
bia. E-mail: lfgomez@fundacionfes.org.
0749-3797/00/$17.00 adults are generally the least active subgroup in any pop-
doi: 10.1016/j.amepre.2010.02.005 ulation; thus, it is possible that the proportion of active

592 Am J Prev Med 2010;38(6):592599 2010 American Journal of Preventive Medicine Published by Elsevier Inc.
Gmez et al / Am J Prev Med 2010;38(6):592599 593
2
older adults in Bogot is even lower as compared to the limits. Neighborhoods mean area was 102.377 m (median
general population. 80,277 m2, SD98,751) and had a population of 4211 people.
Neighborhoods (n1734) were classifed in low, middle-low,
Interventions that involve changes in the built envi-
and middle-high SES using the criteria established by the Mayors
ronment have become a promising opportunity for the Offce of Bogot,23 which uses physical attributes of the housing
promotion of physical activity because they consider (i.e., construction type and materials) and surrounding environ-
structural factors that go beyond the individual level and ments (i.e., road and pedestrian infrastructure) to determine
affect the population at large.1113 Taking into account neighborhood SES. Power analysis was conducted based on the
that the environmental determinants of walking may be expected precision of the estimates to defne the sample design. For
different from those of other physical activity modalities, the frst sampling stage, a probabilistic selection of 58 neighbor-
hoods was made. In a second stage, a random selection of older
particularly among elders, specifc explanatory models
adults who met the following criteria had the probability of being
for walking are needed. In addition, elderly people may be selected: aged 60 years, at least 1 year of residency, not being on
especially susceptible to the residential environments as bed rest at the time of the survey, and having suffcient cognitive
compared to younger populations.14 17 In Latin Amer- capabilities to answer the survey. The fnal sample included 1966
ica, little is known about the association between the built older adults distributed across 50 neighborhoods (approximately
environment and walking patterns among the population 39 older adults per neighborhood); data from eight of the original
as a whole and particularly among the elderly.18,19 58 neighborhoods were not used because of small sample size
(response rate 67.8%). Because of missing values for some of the
As a result of an informal and disorganized pattern of
environmental perception items, the regression analyses showed in
urban development, Bogot has several environmental the current study were restricted to 1886 observations. Sampling
inequities,20,21 which include dispropor- weights were calculated considering the unequal
tionate distribution of public space and probability of selection.
green areas as well as poor quality of
See
housing and road infrastructure. In an Measurement Procedures and Variables
related
effort to counteract these problems, the A face-to-face interview was administered in 2007
Commentary
city has engaged in several social and ur- to each subject by interviewers who were trained
ban changes during the past few de-
by Troiano in
prior to data collection. The interviews had an av-
cades.22 An important feature of the city
this issue. erage duration of 12 minutes. The IRB of the Fun-
is the Ciclova program, in which 121 km dacin FES Social approved the protocol prior to
of the main avenues are closed to motor data collection.
vehicles on Sundays and holidays and Outcome variables. An adapted version of the
opened solely for pedestrians and cy- International Physical Activity Questionnaire
clists. Another urban feature of the city is TransMilenio, a (short-form) was used to determine walking patterns.24 The walk-
ing questions included in the survey were the following: Usually
bus rapid transit system that operates in dedicated traffc
how many days of the week do you walk outside your home in bouts
lanes and has fxed stations. In addition, between 2001 that last at least 10 minutes? and How much time do you usually
and 2003, the green area per inhabitant increased from walk in any of those days?
2.5 to 4.12 m2. These changes could be potentially associ- These questions were adapted taking into account the results of
ated with the likelihood of older adults to engage in phys- semi-structured interviews and focus groups conducted prior to
ical activity, particularly in walking. Hence, the current data collection. The results of this qualitative approach suggested
that it is diffcult for older adults to discriminate between physical
study was set forth to examine the associations between
activity during leisure time and physical activity for utilitarian
the perceived and objective attributes of the residential purposes because there is a combination of these types of activity
built environment and walking patterns among the el- for most individuals.
derly population in Bogot. As the authors were interested in exploring how the built envi-
ronment was associated with low and high levels of walking, two
binary outcome variables were defned: having walked for at least
Methods 60 minutes and having walked for at least 150 minutes during a
usual week. This cut-point was established considering the recently
Study Design and Sample updated U.S. physical activity recommendation guidelines.9 In
A multilevel cross-sectional study was conducted in 2007 using a addition, some evidence9 shows how people who walk for at least
two-stage randomized sampling design in which the neighbor- 60 minutes during the week are less likely to have cardiovascular
hoods and the older adults were the primary and the secondary events as compared to inactive individuals.
units of analysis, respectively. Bogots neighborhoods, as defned
by the Majors Offce, are not homogeneous in terms of SES and Geographic information systemdefined built environ-
physical attributes. As a result, the present study used a different ment variables. Taking into account the specifc urban char-
notion of neighborhood, defned as a residential area of same SES, acteristics of Bogot and feld experience from a previous study
similar urban characteristics, and bounded by urban or natural conducted in this city,18 the following built environment vari-

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594 Gmez et al / Am J Prev Med 2010;38(6):592599
ables were obtained using Table 1. Study population characteristics and built environment variables obtained
GISs: public park density, through a GIS in the 50 neighborhoodsa
street connectivity, pres-
ence of a Ciclova corridor, Number of
and number of TransMile- Variables n neighborhoods M or % Median SD
nio stations.
INDIVIDUAL COVARIATES
These GIS variables were
measured in an as-the- Gender
crow-flies buffer of 500 m Male 737 37.5
around the centroid of each
neighborhood as recom- Female 1229 62.5
mended in an earlier Age (years)
study25 conducted among
an elderly population. Prior 6074 1366 69.5
evidence has shown25 that 7598 600 30.5
in cities with a high connec-
Years of residence in the
tivity index, the differences 1966 24.5 25 16.1
neighborhood
in the built environment in-
dicators calculated using Education level
circular buffers and those Primary school or less 1302 66.2
obtained using network-
based methods do not have More than primary school 664 33.8
meaningful differences. In Walking from your house, how far
addition, a buffer of 500 m do the members of your
would be more appropriate family live?
considering the reduced av- Very far, far, neither 1256 65
erage walking speed of older
adults and the high diversity Close, very close 701 35
of land uses that exists in Missing values 72
Bogot. The average area of
the selected neighborhoods ENVIRONMENTAL COVARIATES
was smaller than the circu- SES of the neighborhoods
lar buffer defned in the
Low 19 38
present study (average area
of neighborhoods102,377 Middle-low 26 52
m2, SD98,751, area of cir-
Middle-upper 5 10
cular buffer785,189 m2),
and none of the selected Slope of the terrain (buffer of
neighborhoods were adja- 500 m)
cent to each other. There is 5% 38 79
some overlap in only a few
of the 500-m buffers and 5% 12 21
mainly among the neigh- GIS BUILT ENVIRONMENT
borhoods that were not in- ATTRIBUTES (BUFFER OF
cluded in the analysis be- 500 m)
cause of small sample size. Ciclova corridorb
Arc View software was
used to generate the infor- Yes 13 26
mation (ArcInfo, version No 37 74
9). c
Number of TransMilenio stations
Public park density was ob-
tainedbydividingthetotalarea 0 33 66
of public parks by the total area 1 9 18
of the buffer and multiplying
2 7 14
by 100. Pocket parks (less than
1000 m2) were not included as 3 1 2
they have not been designed to
Park index 50 6.61 6.14 5.49
promote physical activity
among older adults. Park den- (continued on next page)
sity was classifed into the fol-

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Gmez et al / Am J Prev Med 2010;38(6):592599 595
Table 1. (continued) Individual covariates. In-
dividual covariates included
Number of gender; age groups (60 74
Variables n neighborhoods M or % Median SD and 7598 years); education
level (elementary education
Connectivity index 50 1.77 1.77 0.1149
or less versus more than ele-
Land-use mix 50 0.6346 0.6444 0.0920 mentary education); having a
limitation to engage in phys-
BUILT ENVIRONMENT PERCEPTIONS
ical activity (measured with a
How safe from traffic do you feel single SF8 item27: During the
crossing the streets? past 4 weeks, how much did
Very unsafe, unsafe, neither 1256 64 physical health problems limit
your usual physical activities
Very safe, safe 701 36 [such as walking or climbing
Missing values stairs]? categorized as could
not perform physical activities
How satisfied are you with the quality
and quite a lot versus some-
and maintenance of the
sidewalks? what, very little, and not at
all); and the proximity of a
Very dissatisfied, dissatisfied, neither 1425 72 family member (determined
Satisfied, very satisfied 539 28 by the following question:
Walking from your house,
Missing values
how far do the members from
OUTCOME VARIABLES your family live? categorized
as very close and close versus
Walking for at least 60 minutes during
a usual week neither close nor far, far, and
very far for purposes of the
Yes 1687 85.8 analysis).
No 279 14.2
Environmental covaria-
Walking for at least 150 minutes during tes. SES was measured for
a usual week each neighborhood and cate-
Yes 1226 62.4 gorized as low, middle-low,
and middle-high. This vari-
No 740 37.6 able was shared by the totality
a
500 m around the centroid of each neighborhood of households in each
b
Ciclovaprogram in which 121 km of the main avenues of the city are closed to motor vehicles on neighborhood.
Sundays and holidays and opened solely for pedestrians and cyclists The slope of the terrain
c
TransMileniomass transportation system of Bogot was used as an environmental
control variable and was cal-
lowing tertiles: 0.01%4.14% m2, 4.53%7.98% m2, and 8.11%35.21% culated as vertical distance in meters 100/horizontal distance in
2
m of land covered by parks. meters. This calculation was obtained by averaging the degrees of
Street connectivity was defned as the number of street links slope in a triangulated irregular network (TIN) previously created
divided by the number street nodes within the buffer area. This in the terrain levels. Based on the urban criteria for building pedes-
index ranges from 1 to 2, where 2 represents maximum connectiv- trian ramps, two categories were created: less than 5% of slope and
ity. The connectivity index was classifed into the following tertiles: 5% or more of slope.
1.46 1.74, 1.751.80, and 1.811.99. Binary variables were created
to determine the presence of a Ciclova corridor (yes versus no) and
the presence of TransMilenio stations (yes versus no) within the Statistical Analysis
500-m buffer.18 The data set was cleaned and checked for missing values. The
individual variables and GIS data sets were merged. Proportion,
Environmental perception variables. Based on the results
26 mean, minimum and maximum values, as well as SDs were used to
of focus groups and cognitive interviews conducted prior to data
describe the built environment variables and the sociodemo-
collection, two environmental perception questions were selected
graphic characteristics and walking levels of the study sample.
for this analysis in order to explore their associations with walking
Lowess smoothing curves were created for the public park density,
patterns:
and street connectivity variables and tertiles were defned for pur-
Safety from traffc: categorized as very safe and safe versus nei- poses of the analysis. Presence of a Ciclova corridor (yes versus no)
ther unsafe nor safe, unsafe, and very unsafe. and number of TransMilenio stations (none versus one or more)
Satisfaction with the quality of sidewalks in the place of resi- were treated as binary variables.
dence: categorized as very satisfed and satisfed versus neither Multilevel adjusted models were developed for each outcome
satisfed nor dissatisfed, dissatisfed, and very dissatisfed. variable. Final models included all the GIS environmental percep-

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596 Gmez et al / Am J Prev Med 2010;38(6):592599
tions as well as the individual and environmental covariates. The when crossing the streets (POR1.19, 95% CI0.97,
analysis assumed a random intercept, and regression coeffcients 1.47, p0.088).
were considered as fxed. Collinearity was examined using regres-
sion diagnostic tests. Cross-level interactions were explored but
were not found. To obtain more-accurate estimations, La Place Discussion
approximations were used.28 All statistical analyses were con-
ducted in 2008 with Stata 10 software using the command xt- The present study suggests that both perceived and objective
melogit (Stata, version 10). attributes of the neighborhood built environment are
associated with walking patterns in older adults living in
Results Bogot. In view of the fact that built environment attributes
may link differently with walkingpatternsdependingonthe
Characteristics of the Sample cut-points defned, the present study provides new insights to
Table 1 shows descriptive characteristics of the partici- better understand this issue in the context of a highly urbanized
pants and the neighborhoods included in the analysis. city in Latin America.
The means of age and time of residence in the neighbor- The negative association between street connectivity
hoods were 70.7 (SD7.7) and 24.5 (SD16.1) years, and walking for at least 60 minutes differs from the
respectively. In all, 63% of the participants were women, majority of the evidence gathered from studies29 33 in
and 66% had an education level of primary or less; 35% of Europe and the U.S., as well as previous research18
participants reported that family members lived close or conducted in Bogot among younger adults. These
very close. Slightly more than 85% reported walking for at studies have documented a positive association be-
least 60 minutes during a usual week, and 62.4% reported tween high connectivity levels and physical activity.
walking for at least 150 minutes and more during the One study conducted in Baltimore found a similar
week. result to that found here, documenting a negative as-
sociation between street connectivity and walking
Environmental Variables and Walking at trips,34 and other studies35,36 have found no associa-
Least 60 Minutes per Week tions. These conflicting fndings may be due to differ-
ences in study designs, diverse urban characteristics,
As it is shown in Table 2, older adults who resided in areas
in the highest tertile of the connectivity index (1.811.99) or differences in the sampled population (younger ver-
were signifcantly less likely to walk for at least 60 minutes sus older adults) from the studied cities. The current
during the week as compared to those in the lowest tertile results can in part be explained by the high levels of
(prevalence OR [POR]0.64, 95% CI0.44, 0.93, compactness and connectivity of Bogot. A high con-
p0.021). Those who resided in areas within the middle nectivity level is linked with more intersections and
tertile of public park density (4.537.98) were more pedestrian crosswalks, which could be associated with
likely to walk for at least 60 minutes than those who lived a perception of higher risk of traffc accidents among
in areas within the lowest tertile (POR1.42, 95% older adults, thus discouraging them from walking.
CI1.02, 1.98, p0.039). The slope of the terrain was Public parks density was positively associated with walk-
negatively associated, as those who lived in slope terrain ing for at least 60 minutes during a usual week, which is
(5%) were less likely to walk for at least 60 minutes than similar to the fndings of several studies37,38 conducted in
those in areas with slope of 5% (POR0.61, 95% this area. However, this association was found only among
CI0.38, 0.97, p0.038). Those participants who reported older adults who resided in those areas within the second
feeling safe or very safe from traffc when crossing the streets tertile of public parks density. This could be due to the fact
were more likely to walk for at least 60 minutes than those that the indicator of park density calculated for the present
who felt very unsafe, unsafe, or neither (POR1.50, 95% study included various types of public parks, which may
CI1.11, 2.03, p0.007). have different designs, and did not take into account differ-
ences in the type of equipment or other surrounding at-
Environmental Variables and Walking at tributes, that may facilitate or deter walking among elderly
Least 150 Minutes per Week population.
Ciclova corridor was positively but marginally associ- Although the presence of Ciclova was marginally associ-
ated with having walked for at least 150 minutes during ated with walking for at least 150 minutes during the week,
a usual week (POR1.29, 95% CI0.97, 1.73, this fnding is meaningful and potentially has large public
p0.079). This same marginal and positive association health implications, because this recreational program is
was found with feeling safe or very safe from traffc dedicated to not only bikers but also pedestrians and has

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Gmez et al / Am J Prev Med 2010;38(6):592599 597
Table 2. Multilevel models for walking at least 60 and 150 minutes during a usual which has a high preva-
week among older adults, adjusted POR (95% CI) lence of traffc accidents
involving older adult
Having walked Having walked
>60 minutes/ >150 minutes/
pedestrians in the ma-
Variables week p-value week p-value jority of cases.39
Several study strengths
GIS VARIABLES can be mentioned. The
Slope use of GIS allowed us to
5% 1 1 have objective and robust
measures of the built
5% 0.61 (0.38, 0.97) 0.038 0.80 (0.55, 1.16) 0.254
environment. The inclu-
Ciclova corridora sion of environmental
No 1 1 perceptions complemen-
Yes 1.16 (0.82, 1.65) 0.376 1.29 (0.97, 1.73) 0.079 ted and enriched the anal-
yses presented in the cur-
Connectivity index
rent study. The sampling
1.461.74 1 1 design allowed for com-
1.751.80 0.74 (0.50, 1.10) 0.143 0.79 (0.58, 1.09) 0.163 parison among various
1.811.99 0.64 (0.44, 0.93) 0.021 0.90 (0.67, 1.23) 0.540
urban attributes of geo-
graphic areas from various
Public park density
SES levels, which im-
0.014.14 1 1 proved the external va-
4.537.98 1.42 (1.02, 1.98) 0.039 1.08 (0.81, 1.43) 0.574 lidity of the study. Fi-
nally, the current study
8.1135.21 1.06 (0.74, 1.53) 0.726 0.95 (0.70, 1.29) 0.757
conceived a new defni-
TransMilenio stationsb tion of neighborhood
Zero 1 1 that may reflect more
One or more 0.75 (0.52, 1.08) 0.127 0.78 (0.59, 1.04) 0.101 closely the perceptions
that older adults have of
ENVIRONMENTAL PERCEPTIONS
their micro-territories.
How safe from traffic do you feel A limitation of the cur-
crossing the streets?
rent study is its cross-
Very unsafe, unsafe, neither 1 1 sectional nature, making
Very safe, safe 1.50 (1.11, 2.03) 0.007 1.19 (0.97, 1.47) 0.088 it impossible to deter-
How satisfied are you with the
mine the temporality of
quality and maintenance of the observed associa-
the sidewalks? tions. In addition, be-
Very dissatisfied,
1 1
cause walking levels in
dissatisfied, neither the current study were de-
Satisfied, very satisfied 0.82 (0.61, 1.12) 0.225 0.95 (0.76, 1.19) 0.712 termined through a self-
report instrument, there is
Note: Buffer of 500 m around the neighborhoods. n1886; number of geographic areas50. Models were
adjusted by gender, age groups, education level, limitation to engage in physical activity, slope, and SES. a probability of overesti-
a
Ciclovaprogram in which 121 km of the main avenues of the city are closed to motor vehicles on Sundays mation, as documented in
and holidays and opened solely for pedestrians and cyclists
b
TransMileniomass transportation system in Bogot
several studies.4042 Fi-
POR, prevalence OR nally, the possibility of
self-selection cannot
been identifed as an innovative strategy to promote physical be excluded as people may select their residential areas
activity.22 based on environmental attributes linked with physical
The positive association between the perception of activity. However, the average time of residency in the
traffc safety and walking is consistent with an earlier current study was 24.5 years, and some of the urban
meta-analysis14 and may suggest the need to advocate for changes that have occurred in the city and that were
policy and regulatory actions aimed at improving pedes- assessed in this study were more recent. In addition, in
trian safety. This is particularly important in Bogot, a city where a high percentage of the population lives

June 2010
598 Gmez et al / Am J Prev Med 2010;38(6):592599
below the poverty line, it is likely that the reasons for 10. Instituto Colombiano de Bienestar Familiar. Encuesta Nacional de la
Situacin Nutricional en Colombia. Bogot: ICBF, 2005.
selecting residential areas may have to do more with
11. Sallis JF, Cervero RB, Ascher W, Henderson KA, Kraft MK, Kerr J. An
economic factors rather than environmental ecological approach to creating active living communities. Annu Rev
attributes. Public Health 2006;27:297322.
To the authors knowledge, this is the frst published 12. Ogilvie D, Mitchell R, Mutrie N, Petticrew M, Platt S. Personal and
environmental correlates of active travel and physical activity in a
study exploring the links between perceived and objective
deprived urban population. Int J Behav Nutr Phys Act 2008;5:43.
indicators of the built environment and walking patterns 13. Heath GW, Brownson RC, Kruger J, Miles R, Powell KE, Ramsey LT;
among the elderly population in a Latin American city. Task Force on Community Preventive Services. The effectiveness of
The particular characteristics of the city, including the urban design and land use and transport policies and practices to
increase physical activity: a systematic review. J Phys Act Health
low proportion of sprawling areas, the high level of com-
2006;3:S5576.
pactness of urban forms, the unplanned and disorganized 14. Duncan MJ, Spence JC, Mummery WK. Perceived environment and
urbanization processes that occurred in large parts of the physical activity: a meta-analysis of selected environmental character-
city, as well as other cultural and social aspects, constitute istics. Int J Behav Nutr Phys Act 2005;2:11.
15. Cunningham GO, Michael YL. Concepts guiding the study of the
factors that may help explain some of the results from the
impact of the built environment on physical activity for older adults: a
present study and that are worth further exploration. review of the literature. Am J Health Promot 2004;18(6):435 43.
16. Li F, Fisher J, Brownson RC, Bosworth M. Multilevel modeling of built
environment characteristics related to neighborhood walking activity
This research was supported by a grant from the Depar-
in older adults. J Epidemiol Community Health 2005;59(7):558 64.
tamento Administrativo de Ciencia, Tecnologa e Inno- 17. Berke EM, Koepsell TD, Moudon AV, Hoskins RE, Larson EB. Asso-
vacin, COLCIENCIAS. Many individuals contributed ciation of the built environment with physical activity and obesity in
to this research, and their assistance is acknowledged. In older persons. Am J Public Health 2007;97(3):486 92.
particular, we thank Janeth Mosquera for the cultural 18. Cervero R, Sarmiento OL, Jacoby E, Gmez LF, Neiman A. Influences
of built environments on walking and cycling: lessons from Bogot. Int
adaptation of the self-report instruments. J Sustain Transp 2009;3:20326.
No fnancial disclosures were reported by the authors 19. Parra D, Gomez L, Buchner D, et al. Perceived and objective neighbor-
of this paper. hood environment attributes and health related quality of life among
the elderly in Bogot. Soc Sci Med 2010;70(7):1070 6.
20. Camargo A. Perfl de la informalidad urbana: Principales caractersti-
cas de los asentamientos de origen informal. Bogot: Universidad
Piloto de Colombia, 2005.
References 21. Cerruti M, Bertoncello R. Urbanization and internal migration pat-
1. Nelson ME, Rejeski WJ, Blair SN, et al. Physical activity and public terns in Latin America. In: African Migration in Comparative Perspec-
health in older adults: recommendation from the American College of tive. Johannesburg: Conference on African Migration in Comparative
Sports Medicine and the American Heart Association. Med Sci Sports Perspective, 2003.
Exerc 2007;39(8):1435 45. 22. Parra D, Gmez LF, Pratt M, Samiento OL, Triche EJM. Policy and
2. Keysor J. Does late-life physical activity or exercise prevent or mini- built environment changes in Bogot and their importance in health
mize disablement? A critical review of the scientifc evidence. Am J promotion. Indoor Built Environ 2007;16(4):344 8.
Prev Med 2003;25:129 36. 23. DANE. La estratifcacin en Bogot D.C. y estudios relacionados 1983
3. American Geriatrics Society, British Geriatrics Society, and American 2004. In: Distrital DAdP, ed. Bogot DC: Alcalda Mayor de Bogot
Academy of Orthopaedic Surgeons Panel on Falls Prevention. Guide- DC, 2005.
line for the prevention of falls in older persons. J Am Geriatr Soc 24. International Physical Activity Questionnaire. www.ipaq.ki.se/IPAQ.
2001;49(5):664 72. asp?mnu_selBBA&pg_sel.
4. Angevaren M, Aufdemkampe G, Verhaar HJ, Aleman A, Vanhees L. 25. Oliver LN, Schuurman N, Hall AW. Comparing circular and network
Physical activity and enhanced ftness to improve cognitive function in buffers to examine the influence of land use on walking for leisure and
older people without known cognitive impairment. Cochrane Data- errands. Int J Health Geogr 2007;6:41.
base Syst Rev 2008;(3):CD005381. 26. Jobe JB, Mingay DJ. Cognitive laboratory approach to designing ques-
5. Pate RR, Pratt M, Blair SN, et al. Physical activity and public health. A tionnaires for surveys of the elderly. Public Health Rep 1990;
recommendation from the Centers for Disease Control and Prevention 105(5):518 24.
and the American College of Sports Medicine. JAMA 1995;273(5): 27. QualityMetrics. A manual for users of the SF-8 health survey quality
4027. metrics, 2008.
6. Lee IM, Buchner DM. The importance of walking to public health. Med 28. Raudenbush SW, Bryk AS. Hierarchical linear models: applications
Sci Sports Exerc 2008;40(7S):S512 8. and data analysis methods. 2nd ed. Newbury Park CA: Sage, 2002.
7. Siegel PZ, Brackbill RM, Heath GW. The epidemiology of walking for 29. Frank LD, Kerr J, Sallis JF, Miles R, Chapman J. A hierarchy of socio-
exercise: implications for promoting activity among sedentary groups. demographic and environmental correlates of walking and obesity.
Am J Public Health 1995;85(5):706 10. Prev Med 2008;47(2):172 8.
8. Eyler AA, Brownson RC, Bacak SJ, Housemann RA. The epidemiology 30. Li F, Harmer PA, Cardinal BJ, et al. Built environment, adiposity, and
of walking for physical activity in the U.S. Med Sci Sports Exerc physical activity in adults aged 50 75. Am J Prev Med 2008;
2003;35(9):1529 36. 35(1):38 46.
9. Physical Activity Guidelines Advisory Committee report, 2008. To the 31. Heinrich KM, Lee RE, Suminski RR, et al. Associations between the
Secretary of Health and Human Services. Part A: executive summary. built environment and physical activity in public housing residents. Int
Nutr Rev 2009;67(2):114 20. J Behav Nutr Phys Act 2007;4:56.

www.ajpm-online.net
Gmez et al / Am J Prev Med 2010;38(6):592599 599
32. Cleland VJ, Timperio A, Crawford D. Are perceptions of the phys- 37. Baker EA, Schootman M, Kelly C, Barnidge E. Do recreational
ical and social environment associated with mothers walking for resources contribute to physical activity? J Phys Act Health
leisure and for transport? A longitudinal study. Prev Med 2008;5:252 61.
2008;47(2):188 93. 38. Diez Roux AV, Evenson KR, McGinn AP, et al. Availability of
33. Badland HM, Schofeld GM, Garrett N. Travel behavior and objectively recreational resources and physical activity in adults. Am J Public
measured urban design variables: associations for adults traveling to Health 2007;97(3):4939.
work. Health Place 2008;14(1):8595. 39. SecretaradeMovilidad. Mayores de 60, principales vctimas en acci-
34. Clifton K, Livi A. Gender differences in walking behavior, attitudes dentes. Bogot: Alcalda Mayor de Bogot, 2009.
about walking and perceptions of the environment in three Maryland 40. Johnson-Kozlow M, Sallis JF, Gilpin EA, Rock CL, Pierce JP. Com-
communities. In: Conference on Womens Issues in Transportation; parative validation of the IPAQ and the 7-Day PAR among women
2004 Nov 18 20; Chicago IL. Washington: Transportation Research diagnosed with breast cancer. Int J Behav Nutr Phys Act 2006;3:7.
Board of the National Academies, 2005. 41. Ainsworth BE, Macera CA, Jones DA, et al. Comparison of the 2001
35. Oakes JM, Forsyth A, Schmitz KH. The effects of neighborhood density BRFSS and the IPAQ Physical Activity Questionnaires. Med Sci Sports
and street connectivity on walking behavior: the Twin Cities walking Exerc 2006;38(9):1584 92.
study. Epidemiol Perspect Innov 2007;4:16. 42. Rzewnicki R, Vanden Auweele Y, De Bourdeaudhuij I. Addressing
36. Lovasi GS, Moudon AV, Pearson AL, et al. Using built environment over-reporting on the International Physical Activity Questionnaire
characteristics to predict walking for exercise. In J Health Geogr (IPAQ) telephone survey with a population sample. Public Health Nutr
2008;7:10. 2003;6:299 305.

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According to the 2008 Journal Citation Reports, published by Thomson Reuters, the
2008 impact factor for the American Journal of Preventive Medicine is 3.766.

June 2010

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