January 10, 2005
Healthy Living From the Ground Up
By Karen F. Schmidt

In a new approach to encourage daily exercise, public health experts are working with city planners to make communities more walkable for seniors.

New Year's resolutions, gym memberships, and videos featuring the svelte Suzanne Somers--none has consistently kept Americans off the couch. The U.S. Surgeon General recommends a minimum of 30 minutes of moderate physical activity on most days. Walking, gardening, and chores such as raking leaves appear to bring some health benefits--reducing risks of heart disease, diabetes, colon cancer, disability, and depression, for instance.

Yet seniors, many of whom have free time to exercise and much to gain from it, aren't meeting this modest goal. According to the U.S. Centers for Disease Control and Prevention (CDC), in 2003 two-thirds of adults over age 65 missed the mark. This physical idleness, researchers estimate, causes 200,000 deaths a year and adds $77 billion to our annual health care bill.

Such dismal statistics have forced public health experts to reexamine what keeps most people stuck in a sedentary lifestyle. They discovered that poorly designed cities, suburbs, and towns are working against us. "The more we peeled back the onion, the more we saw issues of land use and sprawl," says Philip Bors, project officer at Active Living by Design, a national program based at the University of North Carolina, Chapel Hill, and funded by the Robert Wood Johnson Foundation. Step out of the house, he says, and most people find hair-raising traffic, dangerous crosswalks, bike lanes that lead to dead ends, cracked and overgrown sidewalks (if there are any), and few appealing destinations within reach. As David Bonk, Chapel Hill's principal transportation planner, puts it, "We can encourage people to get active, but if we don't offer them the means to do it safely and conveniently, it doesn't matter."

So public health professionals have joined forces with planners in a new movement called "active living." They aim to create neighborhoods where residents feel comfortable going out to walk, ride, skate, garden, or jog each day.

This strategy benefits older folks in particular because exercise-friendly places help them stay independent and socially engaged. In 2001, a coalition that includes the National Institute on Aging, CDC, the American Geriatrics Society, AARP, and others called for active living in their blueprint for promoting physical activity in older adults. Richard Jackson, formerly at CDC and now state public health officer for California, wrote in 2003, "It's time for a shift to communities intentionally designed to facilitate physical and mental well-being."

To make this shift, researchers need to know more about what's keeping older folks from getting out and about. Seniors are more likely to suffer from disabilities that limit their mobility, but surveys find that they often avoid walking because of concerns about falling, crime, crossing busy streets, and--particularly for women--going alone, says William Satariano, a community health expert at the University of California, Berkeley. As part of CDC's Healthy Aging Research Network, Satariano's group will this year begin to interview seniors, measure their daily activity, and characterize their environment in the Berkeley-Oakland area. Other researchers in the network will launch studies elsewhere to see if elders' lifestyles differ in rural and urban settings.

The National Institute of Environmental Health Sciences also joined the active living bandwagon in November, when it announced that it would invest $2.8 million over 5 years to evaluate whether changes in community design might curb America's obesity epidemic. The grant builds on the partnerships that Active Living by Design began in 2003 with 25 communities across the country. These pilot projects should help pinpoint which features--sidewalks, parks, community gardens--motivate the most people to get moving.

Cities, suburbs, and rural areas will likely find different ways to encourage active living. In Orlando, Florida--one of the 25 pilot sites--the sidewalks and public transit system are mostly in good shape, but the downtown neighborhood that the project focuses on needs more shade trees and awnings to help walkers beat the heat, more bicycle lanes, and a better mix of retailers, offices, and housing to give people destinations to walk and ride to, says Dean Grandin, the city's planning director. A new grocery store--one designed to encourage walking, with free use of carts to haul purchases home--will soon open there.

Many urban areas are helping people find enjoyable places to stroll. In Seattle, Washington, project participants have created walking maps, which highlight desirable paths, indicate distances, and identify coffee shops that offer public restrooms. The maps offer guidance to walking clubs that depart from senior centers, says David Levinger, executive director of the nonprofit organization Feet First.

Yet seniors need to feel that they can walk safely. In Cleveland, Ohio, older people voiced concerns about crime in the area of Slavic Village, where random attacks occurred last summer. So in August, a group of community volunteers, including some older folks, began regular "safety walks." "This is a way to feel fellowship, do something positive for the community, and get exercise," says Bobbi Reichtell, development officer for Slavic Village. This year a "Friends of the Trail" group will begin bike patrols of the neighborhood's walking and bike trails, she says.

The biggest challenges to active living might be found in less urban areas. Retirees have flocked to the small town of Chapel Hill but find that its sprawling new developments require them to drive everywhere. Bonk's solution has been to promote use of the free public transit system: "Every bus trip starts with a pedestrian trip, so if we encourage bus ridership, we're encouraging physical activity." But it's frustrating, he says, that the new senior center is being built in an outlying area where land is cheap and sidewalks are scarce.

Still, awareness about how communities can be designed to support active living is spreading among planners, mayors, and community leaders, say Bonk and others. "Health is one of the many benefits of good planning; we may not have focused on it before, but we certainly are now," says Orlando's Grandin. If such thinking takes hold, exercise will once again become part of daily life, making it painless, longer lasting than a gym membership, and more satisfying than a video date with Suzanne Somers.

Karen F. Schmidt is a freelance writer in California, where she predicts a new craze will emerge in town halls around 2025: "Senior Disco"!