Background: The world is facing an ageing population. Physical inactivity is considered as the fourth leading risk factor for non-communicable diseases. Walking is recognized as an affordable exercise to elderly people. However there is rarely any systematic review conducted to examine the effect of walking on quality of life of elderly people Objective: This systematic review of randomized controlled trials is to examine the effect of walking on quality of life (QoL) of older people. Methods: Articles were searched through Medline and Ovid by using keywords of “elderly people”, “aged, 50 or more”, “old people”, “elderly”, “the aged”, “walk”, “walking”, “QoL” and “quality of life”. PICO criteria were used for the criteria in selecting articles for this review. CONSORT 2010 checklist was used to assess the quality of included studies. Results and Discussion: 8 articles out of 237 articles from Medline and 883 articles from Ovid were included in this systematic review after applying the inclusion and exclusion criteria. Studies were from 4 different countries. Average age of the subjects was above 60. Subjects were randomized to intervention (walking) and control groups. Outcome measures were QoL indicators. There was significant improvement in various QoL dimensions while other studies have results of either no significant difference between intervention and control groups, or results favoring the control group. Subjects’ adherence was high in the initial phase, yet it was doubtful whether subjects could maintain the habit without the assistance of experimenter and the assisting measures. Conclusions: From this systematic review, the effect of walking on quality of life on elderly people is still unclear. More large scale research works, especially randomized controlled trials are needed to examine the effect of walking on elderly people. / published_or_final_version / Public Health / Master / Master of Public Health

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The aim of this thesis is to demonstrate the importance of walking to public health. The first part is characterized by epidemiological research. First, a typology for the measurement of walking is developed. A systematic review is conducted of observational studies to determine the health benefits of walking in its own right. Studies consistently confirm that 30 minutes walking on most days of the week is sufficient to reduce the risk of cardiovascular diseases and non-communicable disease risk. Then, a series of epidemiological analyses describes the prevalence and correlates of walking, using multiple health and non-health surveillance data sets. Surveillance data indicate that the prevalence of walking at the above recommended levels is low across all domains. Between 1991 and 2001 an increase in walking occurred, and was the main contributor to reductions in leisure time physical inactivity; however, the proportion of the population who achieved the recommended amount of physical activity by walking did not change in leisure and transport domains. The next part of the thesis is characterized by health promotion research examining the impact of three population-based approaches to increasing walking among Australian adults. The first was an evaluation of a conversion of rail to trail, as an environmental change intervention; the second was a mass media campaign promoting walking to work, and the third was a targeted print media walking program. Providing environmental supports with minimal promotion had no effect on walking. A nation-wide mass media campaign promoting walking to work increased walking and other moderate intensity physical activity, but process evaluation indicated other promotional efforts contributed as well. The targeted print media randomised trial had the greatest effect on walking, but the increases were not greater than spontaneous change in the control. Increases in total physical activity were achieved only when the intervention was supplemented by the use of a pedometer. The expectation that broader approaches to the promotion of walking will bring about changes at the population level, were not corroborated by these case studies. There is a need for enhancement of walking-specific interventions to influence total PA at the population levels.

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The aim of this thesis is to demonstrate the importance of walking to public health. The first part is characterized by epidemiological research. First, a typology for the measurement of walking is developed. A systematic review is conducted of observational studies to determine the health benefits of walking in its own right. Studies consistently confirm that 30 minutes walking on most days of the week is sufficient to reduce the risk of cardiovascular diseases and non-communicable disease risk. Then, a series of epidemiological analyses describes the prevalence and correlates of walking, using multiple health and non-health surveillance data sets. Surveillance data indicate that the prevalence of walking at the above recommended levels is low across all domains. Between 1991 and 2001 an increase in walking occurred, and was the main contributor to reductions in leisure time physical inactivity; however, the proportion of the population who achieved the recommended amount of physical activity by walking did not change in leisure and transport domains. The next part of the thesis is characterized by health promotion research examining the impact of three population-based approaches to increasing walking among Australian adults. The first was an evaluation of a conversion of rail to trail, as an environmental change intervention; the second was a mass media campaign promoting walking to work, and the third was a targeted print media walking program. Providing environmental supports with minimal promotion had no effect on walking. A nation-wide mass media campaign promoting walking to work increased walking and other moderate intensity physical activity, but process evaluation indicated other promotional efforts contributed as well. The targeted print media randomised trial had the greatest effect on walking, but the increases were not greater than spontaneous change in the control. Increases in total physical activity were achieved only when the intervention was supplemented by the use of a pedometer. The expectation that broader approaches to the promotion of walking will bring about changes at the population level, were not corroborated by these case studies. There is a need for enhancement of walking-specific interventions to influence total PA at the population levels.

Background: Numerous studies have found that there are many health-related benefits to owning a dog, however, this has not been investigated in a high dense Asian environment where the culture is very different to Western countries. Objectives: This study aimed at investigating 1) if dog-owners are more active than those who do not own a dog; 2) if dog-owners have higher perceived physical and mental health status compared to a sample of the population who do not own a dog; 3) are there social/environmental factors measured by the Dogs-and-Physical Activity (DAPA) tool that are associated with the perceived physical and mental health as well as physical activity (PA) habits of dog owners. Methods: A total of 102 Chinese dog-owners resident in Hong Kong were recruited to examine what factors might affect dog-owners to walk their dog regularly and hence likely to take part in more daily PA. All of these dog-owners were invited to complete a questionnaire that combined the DAPA-tool, Short-Form-12 health survey (SF-12), and the International-Physical-Activity-Questionnaire – short (IPAQ-short) and to wear an accelerometer for a week. Of the 102 recruited dog-owners, 52 had analysable SF-12 and accelerometry data that could be compared with similar data from 47 HK Chinese who did not own dogs. Linear regression was used to analyse differences between dog-owners and non-dog-owners and to examine social/environmental factors that contributed to physical component score (PCS) and mental component score (MCS) and accrued PA of the dog-owners; their living status, gender, age, Body Mass Index (BMI), income, education level and work status were adjusted during the analysis. Result: Compared to those without dogs, dog-owners were found to have higher PCS scores (P<0.001), involved in more moderate to vigorous PA (MVPA, P=0.02) and overall PA (OVPA, P<0.001) as measured by objective accelerometry; while no significant differences were seen in MCS, nor MVPA or OVPA as measured by the self-reported IPAQ. “Owning a dog adds to my happiness” was associated with having higher PCS (P=0.04); whilst “Trees and shrubs for dogs to sniff” (P=0.02), “Sitting areas with benches” (P=0.06) and “My enjoyment of being outdoors” (P=0.01) were positively related to MVPA as measured by IPAQ, whilst “My dog would be unfriendly or difficult to control” (P=0.02) was negatively related to IPAQ MVPA. Furthermore, “Signs to say if dogs are permitted” (P=0.03), “Trees and shrubs for dogs to sniff” (P=0.02), “The fact that I feel safe when walking with my dog” (P=0.02) and “It would keep my dog healthy” (P=0.04) were found to be positively related to OVPA as measure by IPAQ, whilst “My family commitments” (P=0.03) and “It would stop me feeling guilty” (P=0.03) were found to be negative related to IPAQ OVPA. No variables were significantly related to MCS among the dog-owners. Conclusion: Dog-ownership is associated with Hong Kong owners having a more active lifestyle and is related to higher perceived physical, but not mental health. A small number of social and physical factors appear important in providing a supportive environment that can help enhance the health benefits of dog-ownership. / published_or_final_version / Human Performance / Master / Master of Philosophy

Transport systems are essential to trade, globalisation, communication and other forms of interaction between people and societies (Banister, 2013). Yet they can also have negative impacts including decreased quality of life or health impacts arising from pollutants, environmental damage including climate change and a range of wider socio-economic effects (Glanz et al., 1990). Given that most car journeys are short however (57% of UK trips are under five miles), there is particular potential for active travel (i.e. walking and cycling) to both reduce the environmental externalities of modern transport systems and stimulate improved quality of life and societal wellbeing (Banister, 2013; Martin et al., 2014). Unfortunately, there is a paucity of robust evidence that examines how infrastructural interventions (i.e. those aimed at making the physical environment more conducive to active travel) actually impact on active travel levels in specific communities. In addition, there is very limited evidence of the wider effects that such interventions have on wellbeing and levels of happiness overtime. This thesis details mixed-method research undertaken in Cardiff, UK, during 2011/2012, which examined the impacts of a new piece of infrastructure - the Pont-y-Werin walking and cycling bridge - on the local community's levels of active travel and subjective wellbeing. It provides insights into the nature of constraints preventing travel behaviour change from taking place, and - through the use of the novel, 'Day Reconstruction Method' - into the consequences that different modes of travel can have for travel and wellbeing, including on moment-to-moment moods and emotions. Overall by contextualising and measuring and evaluating wellbeing, the research suggests that people experience less pleasant emotions during travel than when undertaking everyday activities, and also that for certain modes there is a decrease in happiness before and after travel compared to everyday activities. Additionally greater monitoring, evaluation and promotion of combined hard and soft measures - focusing on travel behaviour change - is needed alongside providing travellers with accessible information on the wellbeing impacts of different modes (Elvik, 2009).