Neigbourhoods that Encourage Walking among Rotterdam Older ADultS (NEWROADS) [Wijkwandelen].

Physical activity is associated with the risk for various diseases such as cardio-vascular diseases, COPD and depression. Lack of physical activity (PA) is highly prevalent among the Dutch older adults (55+). This is the group with the largest population growth in the next two decades; but also the group facing a large burden of disease. The aforementioned diseases are partly preventable by increasing levels of PA. Moreover in lower SES neighborhoods in Rotterdam PA levels are much lower than nationwide average. Therefore the aim of this study is to promote PA among older adults living in Rotterdam in low SES neighborhoods.



To do so, we will fit with a preferred form of PA for older adults: walking. Environmental interventions may have the potential to reach large groups of people and provide them with a "nudge" to change behavior. There is, however, lack of evidence as to which environmental interventions can be most effective and whether it is the physical, the social or both environments that need to be targeted in order to promote PA. In this project we will therefore develop changes in the physical environment (e.g. walking routes in neighborhoods) and in the social environment (e.g. walking groups) to create a more attractive environment for recreational and utilitarian walking.



The effects of the single and combined environmental interventions on walking among older adults (55+) will be studied in a small-scale 2x2 design in which neighborhoods are
randomised to study condition. In this evaluation study the environmental changes will be evaluated for their effects on walking behaviour (total, recreational and utilitarian), steps (measured by pedometer), levels of physical activity and perceived health. Moreover, explanatory mechanisms will be studied by making use of mediation analyses and the cost-effectiveness of the interventions will be studied.

We hypothesize that:

1. Elderly in each of the intervention neighbourhoods will have more favorable outcomes:

A. Elderly living in neighbourhoods were the both physical and social environmental changes are made will have the most favorable outcomes;

B. Elderly living in neighbourhoods in which either a change to the physical or a change to the social environment was will have more favorable outcomes than elderly living in neighbourhoods were no changes were made.



In addition to testing these main hypotheses, secondary analysis will be performed to answer other relevant research questions.

1. Baseline measurements;

2. First follow-up measurements (3 months);

3. Second follow-up measurement (6 months);

4. Final follow-up measurement (9 months).

Participants will get exposed to a control condition (in which no changes to the environment are made), a physical environmental condition, a social environmental condition or a physical + social environmental condition.



Physical environmental changes:

In the neighbourhoods in which physical environmental changes take place,signed walking routes in the neighbourhood will be created. These routes will be based on preferences of the older adults and go along locations that are interesting and safe for them.



Social environmental changes:

In the neighbourhoods where social environmental changes take place, walking groups will be started which predominantly walk in the neighbourhood.