日足P&Fの状況：（11月17日）～（11月21日）

Previous studies have not investigated the determinants of resting oxidative stress, including physical fitness, as it relates to redox regulation. The present study therefore was aimed at identifying lifestyle and biological factors that determine resting oxidative stress, including objectively measured physical fitness. In 873 middle-aged and elderly men and women, age and anthropometric parameters, lifestyle-related parameters, medication and supplementation status, physical fitness, biochemical parameters, and nutritional intake status, as well as three plasma oxidative stress markers: protein carbonyl (PC), F2-isoprostane (F2-IsoP), and thiobarbituric acid reactive substances (TBARS), were surveyed and measured. The determinants of PC, F2-IsoP, and TBARS in all participants were investigated using stepwise multiple regression analysis. In PC, age (β = -0.11, P = 0.002), leg extension power (β = -0.12, P = 0.008), BMI (β = 0.12, P = 0.004), and HDL-C (β = 0.08, P = 0.040) were included in the regression model (adjusted R 2 = 0.018). In the F2-IsoP, smoking status (β = 0.07, P = 0.060), BMI (β = 0.07, P = 0.054), and HbA1c (β = -0.06, P = 0.089) were included in the regression model (adjusted R 2 = 0.006). In TBARS, glucose (β = 0.18, P < 0.001), CRF (β = 0.16, P < 0.001), age (β = 0.15, P < 0.001), TG (β = 0.11, P = 0.001), antioxidant supplementation (β = 0.10, P = 0.002), and HbA1c (β = -0.13, P = 0.004) were included in the regression model (adjusted R 2 = 0.071). In conclusion, the present study showed that age, anthropometric index, lifestyle-related parameters, medication and supplementation status, objectively measured physical fitness, biochemical parameters, and nutritional intake status explain less than 10% of oxidative stress at rest.

BACKGROUND: Little is known about what timing and intensity of physical activity (PA) are beneficial to preventing children's late sleeping habits. We investigated the association between timing and intensity of PA and late sleeping habits among Japanese children. METHODS: The amount of PA on a weekday (light (>1.5 to <3.0 metabolic equivalents [METs]); moderate (3.0 to <6.0 METs); and vigorous (6.0 to <20.0 METs) was measured for the whole day, before school, during school, and after school, using accelerometers for population-based fourth-grade elementary school and eighth graders for 7 consecutive days between September and December 2018. Late sleeping habit (going to bed after 10 p.m. for fourth graders and after 11 p.m. for eighth graders) was assessed by questionnaires. The data of 229 fourth graders and 182 eighth graders were analyzed with Poisson regression adjusted for grade, gender, household income, body mass index (BMI), belonging to a sports club, wake-up time on weekdays, and PAs with different intensities. RESULTS: Total PA was not associated with late sleeping habits. Light-intensity PA before school was protectively associated with late sleeping habits (prevalence ratio [PR]: 0.82, 95% confidence interval [CI]: 0.68, 0.99) while PA at school or after school was not. CONCLUSION: Light-intensity PA before school may enhance the earlier bedtime of children.

BACKGROUND: Sedentary behaviors and physical activity are likely to be affected by the COVID-19 outbreak, and sedentary lifestyles can increase subjective fatigue. The nonpharmaceutical policies imposed as a result of the COVID-19 pandemic may also have adverse effects on fatigue. OBJECTIVE: This study has two aims: to examine the changes in sedentary behaviors and physical activity of company workers in response to the COVID-19 pandemic in Japan and to examine relationships between changes in these sedentary behaviors and physical activity and changes in fatigue. METHODS: Data from a nationwide prospective online survey conducted in 2019 and 2020 were used. On February 22, 2019, an email with a link to participate in the study was sent to 45,659 workers, aged 20 to 59 years, who were randomly selected from a database of approximately 1 million individuals. A total of 2466 and 1318 participants, who self-reported their occupation as company workers, answered the baseline and follow-up surveys, respectively. Surveys captured fatigue, workday and daily domain-specific sedentary behaviors and physical activity, and total sedentary behaviors and physical activity. We used multivariable linear regression models to estimate associations of changes in sedentary behaviors and physical activity with changes in fatigue. RESULTS: Increases in public transportation sitting during workdays, other leisure sitting time during workdays, and other leisure sitting time were associated with an increase in the motivation aspect of fatigue (b=0.29, 95% CI 0-0.57, P=.048; b=0.40, 95% CI 0.18-0.62, P<.001; and b=0.26, 95% CI 0.07-0.45, P=.007, respectively). Increases in work-related sitting time during workdays, total sitting time during workdays, and total work-related sitting time were significantly associated with an increase in the physical activity aspect of fatigue (b=0.06, 95% CI 0-0.12, P=.03; b=0.05, 95% CI 0.01-0.09, P=.02; and b=0.07, 95% CI 0-0.14, P=.04, respectively). The motivation and physical activity aspects of fatigue increased by 0.06 for each 1-hour increase in total sitting time between baseline and follow-up (b=0.06, 95% CI 0-0.11, P=.045; and b=0.06, 95% CI 0.01-0.10, P=.009, respectively). CONCLUSIONS: Our findings demonstrated that sedentary and active behaviors among company workers in Japan were negatively affected during the COVID-19 outbreak. Increases in several domain-specific sedentary behaviors also contributed to unfavorable changes in workers' fatigue. Social distancing and teleworking amid a pandemic may contribute to the sedentary lifestyle of company workers. Public health interventions are needed to mitigate the negative effects of the COVID-19 pandemic or future pandemics on sedentary and physical activity behaviors and fatigue among company workers.

OBJECTIVES: Reducing sedentary behaviour (SB) and increasing physical activity (PA) have been shown to be associated with decreased depression. However, there are yet few studies examining the potential benefits on older adults' depression, when SB is replaced with PA. This study aimed to examine the associations of objectively assessed SB, light-intensity PA (LPA) and moderate-to-vigorous PA (MVPA) with depression among a sample of Japanese older adults, and to explore impacts of substituting SB with PA on older adults' depression. DESIGN: Cross-sectional analysis. SETTING: General community. PARTICIPANTS: A total of 276 older adults aged 65-85 years living in Japan. MAIN OUTCOME MEASURES: Three behaviours including the average daily time spent in SB (≤1.5 METs); LPA (>1.5 to <3.0 METs) and MVPA (≥3.0 METs) per day were calculated by accelerometers. Depression was assessed using the Japanese version of the 15-item Geriatric Depression Scale (GDS-15). RESULTS: Less SB (β=0.129, 95% CI 0.015 to 0.243) and more LPA (β=-0.138, 95% CI -0.265 to -0.011) were found to be significantly and negatively associated with the GDS-15 score in the single-activity model. The isotemporal substitution model found that replacing only 30 min per day of SB with the same amount of LPA to be significantly and negatively associated with the GDS-15 score (β=-0.131, 95% CI -0.260 to -0.002). CONCLUSIONS: These findings indicated that substituting even small amounts of SB with LPA may contribute to less depression in older adults. Potential favourable effects can be observed for replacing only 30 min per day of SB with LPA.

Purpose: Patients with exercise capacity of 5 metabolic equivalents (METs) are considered to have a high risk of death. The aim of this study was to determine age-related differences in physical activity associated with an exercise capacity of = 5 METs in chronic heart failure (CHF) outpatients. Methods: We enrolled 157 stable CHF patients (79.6% men, age 60.3 +/- 11.5 years). Patients were divided into two age-based groups (middle-aged, 65 years, n = 97) and (older-aged, = 65 years, n = 60). Peak oxygen uptake (peak VO2) was assessed by cardiopulmonary exercise testing. We further divided patients into groups according to exercise capacity: = 5 METs and 5 METs. Physical activity was assessed by measuring the average number of steps/day for 1 week with an electronic pedometer. Results: Receiver-operating characteristic curves were used to select cutoff values for steps associated with an exercise capacity of = 5 METs in the middle- and older-aged patients. Cutoff values of 6045 steps in the middle-aged and 6070 steps in the older-aged patients were determined. Conclusions: Both middle-and older-aged CHF patients with exercise capacity of = 5 METs completed approximately 6000 steps/day. This could become a target amount for minimal physical activity that could contribute to increased exercise capacity in CHF patients.

OBJECTIVES: This study examined cross-sectional and 2-year prospective associations of perceived and objectively measured environmental attributes with screen time among middle-aged Japanese adults. DESIGN: Prospective cohort study. SETTING: Nerima and Kanuma cities of Japan. PARTICIPANTS: Data were collected from adults aged 40-69 years living in two cities of Japan in 2011 (baseline: n=1011; 55.3±8.4 years) and again in 2013 (follow-up: n=533; 52.7% of baseline sample). MEASURES: The exposure variables were five geographic information system-based and perceived attributes of neighbourhood environments (residential density, access to shops and public transport, footpaths, street connectivity), respectively. The outcome variables were baseline screen time (television viewing time and leisure-time internet use) and its change over 2 years. Multilevel generalised linear modelling was used. RESULTS: On average, participants' screen time was not statistically different over 2 years (2.3 hours/day at baseline and 2.2 hours/day at follow-up; P=0.24). There were cross-sectional associations of objective (exp(β): 1.11; 95% CI 1.01 to 1.22) and perceived (1.12; 1.02 to 1.23) good access to public transport, perceived good access to shop (1.18; 1.04 to 1.36) and perceived good street connectivity (1.11; 1.01 to 1.23) with higher time spent in screen time at baseline. No objective and perceived environmental attributes were significantly associated with change in screen time. CONCLUSIONS: Activity-supportive neighbourhood environmental attributes appear to be related to higher levels of screen time cross-sectionally. Pattern of screen time might be maintained rather than changed over time under the same neighbourhood environments. Environmental interventions that promote physical activity may need to consider the potential negative health impact of screen time in Japan.

Background Little is known about the differences in the geriatric nutritional risk index (GNRI) status in older patients and their relationship to accelerometer-derived measures of physical activity (PA) levels. We determined both differences in daily measured PA based on the GNRI and related cut-off values for PA in elderly cardiac inpatients.Methods We divided 235 consecutive elderly cardiac inpatients (mean age 73.6 years, men 70.6 %) into four groups by age and GNRI: older-high group, 65-74 years with high GNRI (= 92 points) (n = 111); older-low group, low GNRI ( 92 points) (n = 30); very old-high group, = 75 years with high GNRI (n = 55); and very old-low group with low GNRI (n = 39). Average step count and physical activity energy expenditure (PAEE in kcal) per day for 2 days of these inpatients were assessed by accelerometer and compared between the four groups to determine cut-off values of PA.Results Step counts and PAEE were significantly lower in the low-GNRI versus high-GNRI groups in the older (2,742.1 vs. 4,198.1 steps, 55.4 vs. 101.3 kcal, P 0.001), and very old (2,469.6 vs. 3,423.7 steps, 54.5 vs. 79.1 kcal, P 0.001) cardiac inpatients. Respective cut-off values for step counts and PAEE were 3,017.6 steps/day and 69.4 kcal (P 0.01) in the older and 2,579.4 steps/day and 58.8 kcal in the very old cardiac inpatients (P 0.01).Conclusion Poor nutritional status, as indicated by a low GNRI, may be a useful predictor of step counts and PAEE. The cut-off values determined in this study might be target values to be attained by older cardiac inpatients.

【目的】先行研究（Izawa et al.,2004,2005）において我々は, 最高酸素摂取量(PVO2)や骨格筋機能などの身体機能指標, 健康関連QOL(HRQOL)およびそれらの媒介変数である身体活動セルフ・エフィカシー(SEPA)に対して, 運動療法を主体とした回復期プログラムがそれらの向上に影響を与えることを報告した. しかし疾患別でのそれら各指標の実態および関連性についての報告は少ない. 本研究の目的は、疾患別の身体機能指標, SEPA,およびHRQOLを比較検討し, HRQOLの関連要因について明らかにすることである.
【方法】 対象は, 当院ハートセンターに急性心筋梗塞(AMI)あるいは心臓外科手術目的で入院後, 急性期プログラムを終了し外来での心肺運動負荷試験（CPX）の依頼があった1924件中, 発症あるいは手術後1か月時点でのCPX, 身体機能指標, SEPAおよびHRQOLの測定を施行した連続600例である. 属性 (年齢, 性別, BMI)に関する情報は診療記録より調査した. 身体機能指標は, 握力, 膝伸展筋力, PVO2を用いた. SEPAはSEPA尺度(2002, 岡)を用い, 上下肢活動に関するSEPAの2項目に分け,その平均値を算出した. HRQOLはSF-36の身体的健康度（PCS）と精神的健康度（MCS）のサマリースコアを用いた. これら各指標について心筋梗塞366例（AMI群）と心臓外科術234例（CS群）の2群間で比較検討し, HRQOLの関連要因を抽出した. 統計学的手法はカイ二乗,t検定および重回帰分析を用いた。統計学的判定の基準は5%未満とした. なお本研究は, 当大学生命倫理委員会の承認を得て施行された.
【結果】結果はAMI群 vs. CS群の順に, 年齢 (61.5 vs. 62.1歳, p=0.55), 性別 (男性の割合, 85 vs. 80% p=0.54), BMI (23.3 vs. 22.1 kg/(m)2, p=0.01), 握力(35.8 vs. 30.6 kg, p=0.01), 膝伸展筋力(1.7 vs. 1.5 Nm/kg, p=0.01), PVO2(24.3 vs. 21.1 ml/kg/min, p=0.01), SEPA (上肢, 64.5 vs. 45.0, 下肢, 69.5 vs. 61.2, p=0.01), PCS (46.7 vs. 43.8, p=0.01), MCS (49.5 vs. 49.1, p=0.52)であった. 重回帰分析の結果, PCSの関連要因としてAMI群は下肢活動のSEPA（R2=0.11, p=0.01）, CS群は上肢活動のSEPA（R2=0.14, p=0.01）が抽出された. 一方, MCSは, AMI群は下肢活動のSEPA（R2=0.12, p=0.01）, CS群は握力と上肢活動のSEPA（R2=0.15, p=0.01）が抽出された.
【考察】CS群はAMI群に比し身体機能, SEPA, PCSは低値を示すことから, 特にCS患者に対するそれらの向上のための配慮が必要であると考えられた. またCS群, AMI群ともにHRQOLの関連要因の一つとして, 媒介変数であるSEPAが少なからず関与することからHRQOLに対するSEPA向上の重要性が示された.

A rapidly growing body of literature has explored associations between urban design attributes, which are conducive to walking, and social capital. The current study aimed to build on the limitations of previous research. Specifically, this study estimated the associations between traditional and novel walkable built environment metrics and social capital among a sample of adults in Japan. Data (n = 1010) from a randomly selected cross-section of residents (40–69 years old) from two areas in Japan were included. Social capital was assessed by questionnaires. Several objective and perceived walkable built environment attributes were calculated. Covariate-adjusted multivariable linear regression models were used to estimate associations between neighborhood built attributes and the three social capital scores. Street connectivity was negatively associated with activities with neighbors (b = -0.21, 95% CI -0.31, -0.11). Perceived population density was negatively associated with all three social capital scores, including social cohesion, activities with neighbors, and social participation (b = -0.21, 95% CI -0.30, -0.11, b = -0.15, 95% CI -0.24, -0.06, and b = -0.16, 95% CI -0.29, -0.02, respectively). Traditional walkability and Walk Score® were negatively associated with activities with neighbors (b = -0.04, 95% CI -0.07, -0.00 and b = -0.09, 95% CI -0.15, -0.04, respectively). No significant associations were observed between perceived walkability and social capital scores. Space syntax walkability was negatively associated with social cohesion and activities with neighbors (b = -0.12, 95% CI -0.23, -0.01 and b = -0.11, 95% CI -0.21, -0.01, respectively). This study provided unique findings demonstrating that walkable built environments may not necessarily support social capital in ultrahigh-density Asian cities.

In addition to intensity and quality, diversity of activity will be an important factor to explain health outcomes among older adults. Few studies, though, examined an association between activity diversity and health outcomes. This study aimed to examine the association between activity diversity and frailty among community-dwelling older Japanese. Participants were community-dwelling older adults who participated in a cohort study, the “Otassya-Kenshin” in 2018 . The participants were asked frequency of 20 daily activities, inside/outside chores, leisure activities with/without physically, direct/indirect contact with friends and so on, in a week and activity diversity score were calculated using the formula of Shannon’s entropy. Frailty was defined by the Japanese version of the Cardiovascular Health Study criteria. The difference in diversity score between frail and non frail were examined by t-test. Logistic regression analysis with covariates, age, sex, economic status, living alone, BMI, Mini-Mental State Examination, and IADL was adopted to find association between activity diversity score and presence of frailty. Of 652 participants (age: 72.8±6.3, women: 60.6%) analyzed, 27 (4.1%) were defined as frail. Frailty group revealed significantly lower activity diversity score than non-frailty group (0.66±0.11 vs 0.75±0.08, Plt;0.01). 0.2 point of decrease in diversity score increase 5 times chance of frailty after controlling covariates. We found significant relationship between activity diversity and health outcome among older subjects. The activity diversity may provide additional information to number or intensity of activity.

Background: In the rapidly developing use of the Internet in society, eHealth literacy-having the skills to utilize health information on the Internet-has become an important prerequisite for promoting healthy behavior. However, little is known about whether eHealth literacy is associated with health behavior in a representative sample of adult Internet users.Objective: The aim of this study was to examine the association between eHealth literacy and general health behavior (cigarette smoking, physical exercise, alcohol consumption, sleeping hours, eating breakfast, eating between meals, and balanced nutrition) among adult Internet users in Japan.Methods: The participants were recruited among registrants of a Japanese Internet research service company and asked to answer a cross-sectional Internet-based survey in 2012. The potential respondents (N= 10,178) were randomly and blindly invited via email from the registrants in accordance with the set sample size and other attributes. eHealth literacy was assessed using the Japanese version of the eHealth Literacy Scale. The self-reported health behaviors investigated included never smoking cigarettes, physical exercise, alcohol consumption, sleeping hours, eating breakfast, not eating between meals, and balanced nutrition. We obtained details of sociodemographic attributes (sex, age, marital status, educational attainment, and household income level) and frequency of conducting Internet searches. To determine the association of each health behavior with eHealth literacy, we performed a logistic regression analysis; we adjusted for sociodemographic attributes and frequency of Internet searching as well as for other health behaviors that were statistically significant with respect to eHealth literacy in univariate analyses.Results: We analyzed the data of 2115 adults (response rate: 24.04%, 2142/10,178; male: 49.74%, 1052/2115; age: mean 39.7, SD 10.9 years) who responded to the survey. Logistic regression analysis showed that individuals with high eHealth literacy were significantly more likely to exhibit the good health behaviors of physical exercise (adjusted odds ratio [AOR] 1.377, 95% CI 1.131-1.678) and eating a balanced diet (AOR 1.572, 95% CI 1.274-1.940) than individuals with low eHealth literacy.Conclusions: We found that some health behaviors, including exercise and balanced nutrition, were independently associated with eHealth literacy among Japanese adult Internet users.

Workplace settings-both internal and external-can influence how workers are physically active or sedentary. Although research has identified some indoor environmental attributes associated with sitting at work, few studies have examined associations of workplace neighbourhood built-environment attributes with workplace sitting time. We examined the cross-sectional associations of perceived and objective workplace neighbourhood built-environment attributes with sitting time at work and for transport among desk-based workers in Japan. Data were collected from a nationwide online survey. The Abbreviated Neighborhood Environment Walkability Scale (n = 2137) and Walk Score® (for a subsample of participants; n = 1163) were used to assess perceived and objective built-environment attributes of workplace neighbourhoods. Self-reported daily average sitting time at work, in cars and in public transport was measured using a Japanese validated questionnaire. Linear regression models estimated the associations of workplace neighbourhood built-environment attributes with sitting time. All perceived workplace neighbourhood built-environment attributes were positively correlated with Walk Score®. However, statistically significant associations with Walk Score® were found for sitting for transport but not for sitting at work. Workers who perceived their workplace neighbourhoods to be more walkable reported a longer time sitting at work and in public transport but a shorter sitting time in cars. Our findings suggest that walkable workplace neighbourhoods may discourage longer car use but have workplaces where workers spend a long time sitting at work. The latter finding further suggests that there may be missed opportunities for desk-based workers to reduce sitting time. Future workplace interventions to reduce sitting time may be developed, taking advantage of the opportunities to take time away from work in workplace neighbourhoods.

IntroductionThe most effective type of social participation against psychological distress in older adults is not well documented. The aim of this study was to examine whether different types of social participation are associated with changes in psychological distress level in older men and women in Japan.MethodsTwo thousand seven hundred community-dwelling older adults (aged 65-74 years, 50% women) were randomly selected from the resident registry of three cities. Of these, participants who reported social participation and psychological distress level in the baseline survey in 2010 were followed up. Psychological distress was evaluated based on K6 scales at baseline and follow-up (in 2015). Social participation level was examined using question items from the National Health and Nutrition Survey in Japan. Exploratory factor analysis was used to derive the underlying factor structure. Multiple linear regression analysis was used to examine the association between social participation and changes in psychological distress level after adjusting for covariates stratified by both gender and age group or living arrangement.ResultsData from 825 community-dwelling older adults (45.3% women) were analyzed. Social participation was categorized into two types using factor analysis: community involvement (volunteer activities, community events, clubs for the elderly) and individual relationship (friendship, communication with family and friends, hobbies). During the 5-year follow-up, 29.5% of participants reported a deterioration in psychological distress. Higher community involvement was independently associated with lower risk of psychological distress for older women (beta = 0.099, p = 0.047), whereas there were no associations with individual relationship for either gender. Furthermore, in older women living with others, higher community involvement was also associated with lower risk of psychological distress (beta = 0.110, p = 0.048).ConclusionCommunity involvement provides older women with mental health benefits regardless of individual relationship level. Promoting community involvement may be an effective strategy for healthy mental aging.

Background: In addition to insufficient moderate-to-vigorous physical activity (MVPA), prolonged sitting time is also a health risk for older adults. An understanding of population subgroups who have prolonged television viewing (TV) time, a predominant sedentary behavior, can aid in the development of relevant health promotion initiatives; however, few such studies have focused on older adults, the most sedentary segment of the population as a whole. The aim of this study is to examine the socio-demographic attributes associated with TV time among community-dwelling Japanese older men and women.Methods: A population-based, cross-sectional mail survey was used to collect data on TV time, MVPA, and socio-demographic characteristics. The survey was conducted from February through March 2010. Participants were 2700 community-dwelling older adults (aged 65-74 years, 50% men) who were randomly selected from the registry of residential addresses of three cities in Japan. Data from 1665 participants (mean age: 69.5 years, 52% men) who completed all variables for the present study were analyzed. Multivariate logistic regression analyses were used to calculate the odds ratios (ORs) of prolonged TV time (2 hours/day) for each socio-demographic attribute, stratified by gender.Results: Of the 1665 participants, 810 (48.6%) watched TV for more than 2 hours/day. The median television viewing time (25th, 75th percentile) was 2.00 (1.07, 3.50) hours/day. Prolonged TV time was associated with not in full-time employment, lower educational attainment, weight status, living in regional areas and low MVPA for the whole sample. For men, prolonged TV time was associated with lower educational attainment; (OR = 1.53, 95% CI: 1.12 2.07), underweight (OR = 1.63, 95% CI: 1.02-2.60), overweight (OR = 1.57, 95% CI: 1.11-2.21), and low MVPA (OR = 1.43, 95% CI: 1.02-2.02). For women, living in regional areas (OR = 2.02, 95% CI: 1.33-3.08), living alone (OR = 1.61, 95% CI: 1.03-2.49), not driving (OR = 1.79, 95% CI 1.21-2.65), overweight (OR = 1.50, 95% CI: 1.00-2.24), and low MVPA (OR = 1.51. 95% CI: 1.05-2.17) were associated with prolonged TV time.Conclusions: These findings identify particular socio-demographic and behavioral characteristics related to TV time among Japanese older adults. It should be noted that correlates of prolonged TV time differed by gender. Women in living situations with limited transportation options tended to spend prolonged time watching TV. Health promotion initiatives for older adults, particularly for older women, may be more effective if they take these attributes into account.

Objective

We examined (1) cross-sectional and prospective associations of perceived and objectively-measured neighborhood attributes with purpose-specific walking; (2) the differences between cross-sectional and prospective associations in the sample of Japanese middle-to-older-aged adults.
Methods

We conducted a prospective cohort study to collect data from 544 adults aged 40 to 69 years living in two cities in Japan in 2011 and again in 2013. Generalized linear modelling was employed to examine associations of perceived and GIS-measured built environment attributes (population density, access to destinations, access to public transportation, sidewalk, and street connectivity) with four types of self-reported purpose-specific walking, namely walking for commuting (to and from work), walking during work, walking for errands (shopping, to the bank or post office), and walking for exercise.
Results

After adjusting for potential confounders, GIS-measured higher population density and better street connectivity were associated with increased time spent walking for commuting and exercise. Furthermore, GIS-measured better access to public transportation was related to increased time spent walking for commuting, and perceived better access to destinations was also associated with increased time spent walking for commuting and daily errands. Unexpectedly, GIS-measured better access to destinations, and perceived sidewalk presence were related to decreased time spent in work-related walking.
Conclusion

Living in high-density neighborhoods with well-connected streets and convenient public transportation systems, and having a higher awareness of destinations are supportive of the long-term engagement in walking for various purposes. Further studies using a prospective design with longer follow-up period to confirm these results are warranted.