Bu Saad, Mohammed
(2023)
The Role of the Built Environment in Physical Activity Changes and Cardiometabolic Outcomes Among Lifestyle Modification Intervention Participants.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
Abstract
INTRODUCTION: More novel approaches to improve health outcomes for at-risk individuals are needed as type 2 diabetes grows. Neighborhood walkability and physical activity (PA) have been found to be related in adult population research. However, whether walkability influences people's ability to change their lifestyle behaviors and improve their cardiometabolic outcomes as a result of a lifestyle intervention is unknown.
METHODS: We examined the association between neighborhood walkability and the six-month changes in (1) physical activity and (2) cardiometabolic outcomes among individuals at risk of diabetes using two cohorts of participants (n=390) who were enrolled in DPP-based community lifestyle interventions (DPP-GLB). In addition, for participants (n=221) undergoing a DPP-based online lifestyle intervention in primary care settings (OCELOT study), we examined participants’ success in (3) meeting a step counts/day equivalent of the program PA goal and the role of neighborhood walkability in PA achievement at 12 months post-intervention. Regression analyses were applied (1: linear; 2: linear and logistic; and 3: logistic).
RESULTS: For DPP-GLB participants, self-reported baseline PA levels were positively associated with greater neighborhood walkability. Over 6 months of intervention neighborhood walkability was inversely associated with PA change. Living in a car-dependent neighborhood versus walkable neighborhood was associated with a statistically significant greater increase in self-reported PA, leading to reduced differences in PA levels across neighborhood walkability categories. Neighborhood walkability was also inversely related to improvements in insulin and blood glucose, but positively associated with blood pressure improvements. In the OCELOT cohort, pedometer-measured PA goal achievement did not differ across the study arms (VLM-S: standard coaching; VLM-M: modulated coaching; OGR: control arm). Regarding PA goal achievement by neighborhood walkability, participants living in walkable neighborhoods (Very Walkable and Walker's Paradise) were more likely to meet the PA goal than those living in car-dependent neighborhoods.
CONCLUSIONS: This dissertation provides valuable evidence regarding the association between neighborhood walkability and PA goal achievement and changes in cardiometabolic outcomes among adults at risk for or with T2DM while participating in a lifestyle intervention. These results suggest that prevention programs should incorporate contextual factors of participants' neighborhoods in their program materials and start considering multi-level intervention approaches.
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Details
| Item Type: |
University of Pittsburgh ETD
|
| Status: |
Unpublished |
| Creators/Authors: |
|
| ETD Committee: |
|
| Date: |
28 June 2023 |
| Date Type: |
Publication |
| Defense Date: |
15 March 2023 |
| Approval Date: |
28 June 2023 |
| Submission Date: |
9 June 2023 |
| Access Restriction: |
2 year -- Restrict access to University of Pittsburgh for a period of 2 years. |
| Number of Pages: |
201 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Public Health > Epidemiology |
| Degree: |
DrPH - Doctor of Public Health |
| Thesis Type: |
Doctoral Dissertation |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
type 2 diabetes, physical activity, neighborhood walkability, cardiometabolic outcomes, lifestyle intervention |
| Date Deposited: |
28 Jun 2023 16:14 |
| Last Modified: |
28 Jun 2023 16:14 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/44963 |
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