Re-thinking Walkability: Synergizing the Pedestrian Environment and Land Use Patterns to Promote Physical Activity in Older Adults.

Previous studies have demonstrated that the macro-level design of cities (e.g., walkability) and the micro-level pedestrian-oriented design of streetscapes are associated with physical activity; however, the benefits of combining these features have rarely been examined. Understanding potential synergies between these two components could provide guidance for optimizing health impacts, especially for older adults. This cross-sectional investigation examined interactions among 'macro-level' neighbourhood walkability and 'micro-level' pedestrian environment, sex, and neighbourhood income in relation to self-reported frequency of active transportation and device-measured physical activity (30 minutes per day) in 352 older adults recruited from economically and built environmentally diverse neighbourhoods in Seattle/King County. Results included positive interactions between neighbourhood walkability, pedestrian environment, and sex for the active transportation outcome. The synergy was more pronounced in women, in which there were significant interactions between neighbourhood walkability and sex with scores related to streetscape design features, walking routes, and street-crossing characteristics of the pedestrian environment. Our study highlights actionable policies to create age-friendly pedestrian environments by improving route connectivity, streetscape features, and crossing safety. Prioritizing well-connected walking routes, enhancing micro-level streetscape elements, and ensuring pedestrian-friendly crossings can significantly support elderly active travel and reduce reliance on motorized transport. These results provide evidence that the pedestrian environment may enhance the health potential of neighbourhood walkability for some population segments (i.e., older women).