Restricted accessResearch articleFirst published online 2025
Do Falling Frequency and Neighborhood Environment Jointly Influence Physical Activity Behavior in Midlife and Older Adults?: A Longitudinal Investigation
Objective: Drawing upon the socio-ecological framework, this study examines whether the neighborhood environment moderates the relation between falling frequency and physical activity (PA) behavior among adults 55 years or older. Methods: At baseline, participants (N = 430) reported number of falls during the past 12 months and leisure-time PA during the past month. At follow-up, PA was assessed weekly using the Physical Activity Scale for Elderly for four consecutive weeks. We used the Bike ScoreTM, Walk Score®, and Index of Relative Rurality to capture objective attributes of the neighborhood environment. Results: The relation between falling frequency and PA was negative and tended to be stronger for recurrent fallers who lived in a neighborhood environment that was less bikeable, less walkable, and more rural. Discussion: This study offers novel quantitative insights that underscore the importance of examining how personal and environmental factors combine to influence PA behavior in the context of fall prevention and management.
AmireaultS. (2014). Doing more than just acknowledging attrition at follow-up: A comment on Lu, Cheng, and Chen (2013). Psychological Reports, 115(2), 419–426. https://doi.org/10.2466/03.PR0.115c19z5
2.
AmireaultS.BaierJ. M.SpencerJ. R. (2019). Physical activity preferences among older adults: A systematic review. Journal of Aging and Physical Activity, 27(1), 128–139. https://doi.org/10.1123/japa.2017-0234
3.
AmireaultS.GodinG. (2014). Validation of using fitness center attendance electronic records to assess the frequency of moderate/vigorous leisure-time physical activity among adults. Measurement in Physical Education and Exercise Science, 18(1), 13–30. https://doi.org/10.1080/1091367X.2013.831765
4.
BaierJ. M. (2019). Autonomy support, satisfaction of the need for autonomy, and autonomous regulation for physical activity in older adults. Thesis: Purdue University Graduate School. https://doi.org/10.25394/PGS.8966270.v1
5.
BronfenbrennerU. (1979). The ecology of human development: Experiments by nature and design. Harvard University Press. https://doi.org/10.2307/j.ctv26071r6 (Accessed 19 March 2024).
6.
CarrL. J.DunsigerS. I.MarcusB. H. (2011). Validation of walk score for estimating access to walkable amenities. British Journal of Sports Medicine, 45(14), 1144–1148. https://doi.org/10.1136/BJSM.2009.069609
7.
ChaudhuryH.OswaldF. (2019). Advancing understanding of person-environment interaction in later life: One step further. Journal of Aging Studies, 51, 100821. https://doi.org/10.1016/J.JAGING.2019.100821
8.
ChippendaleT.BoltzM. (2015). The neighborhood environment: Perceived fall risk, resources, and strategies for fall prevention. The Gerontologist, 55(4), 575–583. https://doi.org/10.1093/geront/gnu019
9.
ChippendaleT.LeeC. D. (2018). Characteristics and fall experiences of older adults with and without fear of falling outdoors. Aging & Mental Health, 22(6), 849–855. https://doi.org/10.1080/13607863.2017.1309639
10.
ChoiB. C. K.PakA. W. P. (2005). A catalog of biases in questionnaires. Preventing Chronic Disease, 2(1), A13.
11.
ChoiN. G.MartiC. N.ChoiB. Y.KunikM. M. (2023). Recurrent falls over three years among older adults age 70+: Associations with physical and mental health statues, exercise, and hospital stay. Journal of Applied Gerontology: The Official Journal of the Southern Gerontological Society, 42(5), 1089–1100. https://doi.org/10.1177/07334648221150884
12.
CurlA.FittH.TomintzM. (2020). Experiences of the built environment, falls and fear of falling outdoors among older adults: An exploratory study and future directions. International Journal of Environmental Research and Public Health, 17(4), 1224. https://doi.org/10.3390/ijerph17041224
13.
DingerM. K.OmanF.TaylorE. L.VeselyS. K.AbleJ. (2004). Stability and convergent validity of the physical activity scale for the elderly (PASE). The Journal of Sports Medicine and Physical Fitness, 44(2), 186–192.
14.
DiPietroL. (2001). Physical activity in aging: Changes in patterns and their relationship to health and function. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 56(suppl 2), 13–22. https://doi.org/10.1093/gerona/56.suppl_2.13
15.
DuS.WangC.MaoL. (2024). Exploring the influence of the perceived neighborhood built environment on the fall risks among older adults in China. Buildings, 14(9), 2631. https://doi.org/10.3390/buildings14092631
16.
DuncanD. T.AldstadtJ.WhalenJ.MellyS. J.GortmakerS. L. (2011). Validation of Walk Score® for estimating neighborhood walkability: An analysis of four US metropolitan areas. International Journal of Environmental Research and Public Health, 8(11), 4160–4179. https://doi.org/10.3390/ijerph8114160
17.
FinlayJ.WestrickA. C.GuzmanV.MeltzerG. (2023). Neighborhood built environments and health in later life: A literature review. Journal of Aging and Health, 37(1-2), 3–17. https://doi.org/10.1177/08982643231217776
18.
FlorenceC. S.BergenG.AtherlyA.BurnsE.StevensJ.DrakeC. (2018). Medical costs of fatal and nonfatal falls in older adults. Journal of the American Geriatrics Society, 66(4), 693–698. https://doi.org/10.1111/jgs.15304
19.
FrancoM. R.TongA.HowardK.SherringtonC.FerreiraP. H.PintoR. Z.FerreiraM. L. (2015). Older people’s perspectives on participation in physical activity: A systematic review and thematic synthesis of qualitative literature. British Journal of Sports Medicine, 49(19), 1268–1276. https://doi.org/10.1136/bjsports-2014-094015
20.
FrazierP. A.TixA. P.BarronK. E. (2004). Testing moderator and mediator effects in counseling psychology research. Journal of Counseling Psychology, 51(1), 115–134. https://doi.org/10.1037/0022-0167.51.1.115
21.
GanzD. A.HigashiT.RubensteinL. Z. (2005). Monitoring falls in cohort studies of community-dwelling older people: Effect of the recall interval. Journal of the American Geriatrics Society, 53(12), 2190–2194. https://doi.org/10.1111/J.1532-5415.2005.00509.X
22.
GionetN. J.GodinG. (1989). Self-reported exercise behavior of employees: A validity study. Journal of Occupational Medicine, Official Publication of the Industrial Medical Association, 31(12), 969–973. https://doi.org/10.1097/00043764-198912000-00007
GrossmanD. C.CurryS. J.OwensD. K.BarryM. J.CaugheyA. B.DavidsonK. W.DoubeniC. A.EplingJ. W.KemperA. R.KristA. H.KubikM.LandefeldS.MangioneC. M.PignoneM.SilversteinM.SimonM. A.TsengC. W. (2018). Interventions to prevent falls in community-dwelling older adults: US preventive services task force recommendation statement. JAMA, 319(16), 1696–1704. https://doi.org/10.1001/jama.2018.3097
25.
HallC. M.RamY. (2018). Walk score® and its potential contribution to the study of active transport and walkability: A critical and systematic review. Transportation Research Part D: Transport and Environment, 61(Part B), 310–324. https://doi.org/10.1016/j.trd.2017.12.018
26.
HansenA. Y.Umstattd MeyerM. R.LenardsonJ. D.HartleyD. (2015). Built environments and active living in rural and remote areas: A review of the literature. Current Obesity Reports, 4(4), 484–493. https://doi.org/10.1007/S13679-015-0180-9
27.
HaradaN. D.ChiuV.KingA. C.StewartA. L. (2001). An evaluation of three self-report physical activity instruments for older adults. Medicine & Science in Sports & Exercise, 33(6), 962–970. https://doi.org/10.1097/00005768-200106000-00016
28.
HayesA. F. (2018). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. In HayesA. F. (Ed.), (2nd ed.). The Guilford Press.
29.
HayesA. F.CouttsJ. J. (2020). Use Omega rather than Cronbach’s alpha for estimating reliability. But…. Communication Methods and Measures, 14(1), 1–24. https://doi.org/10.1080/19312458.2020.1718629
30.
HopewellS.AdedireO.CopseyB. J.BonifaceG. J.SherringtonC.ClemsonL.CloseJ. C. T.LambS. E. (2018). Multifactorial and multiple component interventions for preventing falls in older people living in the community. The Cochrane Database of Systematic Reviews, 7(7), CD012221. https://doi.org/10.1002/14651858.CD012221.pub2
31.
HuffmanM. K.ChristS. L.FerraroK. F.KlenoskyD. B.MarceauK.AmireaultS. (2022). Measuring physical activity regulatory styles and identity among adults 55 years or older. Journal of Aging and Health, 34(6–8), 775–785. https://doi.org/10.1177/08982643211063349
32.
JacobsenE.RanX.LiuA.ChangC. C. H.GanguliM. (2021). Predictors of attrition in a longitudinal population-based study of aging. International Psychogeriatrics, 33(8), 767–778. https://doi.org/10.1017/S1041610220000447
33.
JamesS. L.LucchesiL. R.BisignanoC.CastleC. D.DingelsZ. V.FoxJ. T.HamiltonE. B.HenryN. J.KrohnK. J.LiuZ.MccrackenD.NixonM. R.RobertsN. L. S.SylteD. O.AdsuarJ. C.AroraA.BriggsA. M.Collado-MateoD.CooperC.MurrayC. J. L. (2020). The global burden of falls: Global, regional and national estimates of morbidity and mortality from the Global Burden of Disease Study 2017. Injury Prevention: Journal of the International Society for Child and Adolescent Injury Prevention, 26(Suppl 2), i3–i11. https://doi.org/10.1136/injuryprev-2019-043286
34.
JefferisB. J.IliffeS.KendrickD.KerseN.TrostS.LennonL. T.AshS.SartiniC.MorrisR. W.WannametheeS. G.WhincupP. H. (2014). How are falls and fear of falling associated with objectively measured physical activity in a cohort of community-dwelling older men?BMC Geriatrics, 14(1), 114. https://doi.org/10.1186/1471-2318-14-114
35.
Jian-YuE.MihailovicA.SchrackJ. A.GarzonC.LiT.FriedmanD. S.WestS. K.GitlinL. N.RamuluP. Y. (2021). Longitudinal changes in daily patterns of objectively measured physical activity after falls in older adults with varying degrees of glaucoma. eClinicalMedicine, 40, 101097. https://doi.org/10.1016/j.eclinm.2021.101097
36.
KakaraR.BergenG.BurnsE.StevensM. (2023). Nonfatal and fatal falls among adults aged ≥65 years — United States, 2020–2021. MMWR. Morbidity and Mortality Weekly Report, 72(35), 938–943. https://doi.org/10.15585/MMWR.MM7235A1
37.
KelseyJ. L.Procter-GrayE.HannanM. T.LiW. (2012). Heterogeneity of falls among older adults: Implications for public health prevention. American Journal of Public Health, 102(11), 2149–2156. https://doi.org/10.2105/ajph.2012.300677
38.
LeeS.LeeC.OryM. G.WonJ.TowneS. D.WangS.ForjuohS. N. (2018). Fear of outdoor falling among community-dwelling middle-aged and older adults: The role of neighborhood environments. The Gerontologist, 58(6), 1065–1074. https://doi.org/10.1093/geront/gnx123
39.
LeysC.KleinO.DominicyY.LeyC. (2018). Detecting multivariate outliers: Use a robust variant of the Mahalanobis distance. Journal of Experimental Social Psychology, 74, 150–156. https://doi.org/10.1016/j.jesp.2017.09.011
40.
LoA. X.RundleA. G.BuysD.KennedyR. E.SawyerP.AllmanR. M.BrownC. J. (2016). Neighborhood disadvantage and life-space mobility are associated with incident falls in community-dwelling older adults. Journal of the American Geriatrics Society, 64(11), 2218–2225. https://doi.org/10.1111/jgs.14353
41.
MarklandD.TobinV. (2004). A modification to the behavioural regulation in exercise questionnaire to include an assessment of a motivation. Journal of Sport & Exercise Psychology, 26(2), 191–196. https://doi.org/10.1123/jsep.26.2.191
42.
MarsdenA. M.DixonW. G.DunnG.EmsleyR. (2022). The impact of moderator by confounder interactions in the assessment of treatment effect modification: A simulation study. BMC Medical Research Methodology, 22(1), 1–11. https://doi.org/10.1186/S12874-022-01519-7/tables/3
43.
MatthewsC. E.MooreS. C.GeorgeS. M.SampsonJ.BowlesH. R. (2012). Improving self-reports of active and sedentary behaviors in large epidemiologic studies. Exercise and Sport Sciences Reviews, 40(3), 118–126. https://doi.org/10.1097/JES.0B013E31825B34A0
44.
McClellandG. H.JuddC. M. (1993). Statistical difficulties of detecting interactions and moderator effects. Psychological Bulletin, 114(2), 376–390. https://doi.org/10.1037/0033-2909.114.2.376
45.
McEachanR. R. C.ConnerM.TaylorN. J.LawtonR. J. (2011). Prospective prediction of health-related behaviours with the theory of planned behaviour: A meta-analysis. Health Psychology Review, 5(2), 97–144. https://doi.org/10.1080/17437199.2010.521684
46.
MeredithS. J.CoxN. J.IbrahimK.HigsonJ.McNiffJ.MitchellS.RutherfordM.WijayendranA.ShenkinS. D.KilgourA. H. M.LimS. E. R. (2023). Factors that influence older adults’ participation in physical activity: A systematic review of qualitative studies. Age and Ageing, 52(8), 1–15. https://doi.org/10.1093/ageing/afad145
47.
MiltonK.ClemesS.BullF. (2013). Can a single question provide an accurate measure of physical activity?British Journal of Sports Medicine, 47(1), 44–48. https://doi.org/10.1136/bjsports-2011-090899
48.
Montero-OdassoM.Van Der VeldeN.MartinF. C.PetrovicM.TanM. P.RygJ.Aguilar-NavarroS.AlexanderN. B.BeckerC.BlainH.BourkeR.CameronI. D.CamicioliR.ClemsonL.CloseJ.DelbaereK.DuanL.DuqueG.DyerS. M.Rixt ZijlstraG. A. (2022). World guidelines for falls prevention and management for older adults: A global initiative. Age and Ageing, 51(9), 1–36. https://doi.org/10.1093/ageing/afac205
49.
MorleyJ. E. (2002). Editorial: A fall is a major event in the life of an older person. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 57(8), 492–495. https://doi.org/10.1093/gerona/57.8.M492
50.
MullanE.MarklandD.IngledewD. K. (1997). A graded conceptualisation of self-determination in the regulation of exercise behaviour: Development of a measure using confirmatory factor analytic procedures. Personality and Individual Differences, 23(5), 745–752. https://doi.org/10.1016/S0191-8869(97)00107-4
51.
NascimentoC. F. doDuarteY. A. O.LebrãoM. L.Chiavegatto FilhoA. D. P. (2018). Individual and neighborhood factors associated with functional mobility and falls in elderly residents of São Paulo, Brazil: A multilevel analysis. Journal of Aging and Health, 30(1), 118–139. https://doi.org/10.1177/0898264316669229
52.
NicklettE. J.LohmanM. C.SmithM. L. (2017). Neighborhood environment and falls among community-dwelling older adults. International Journal of Environmental Research and Public Health, 14(2), 175. https://doi.org/10.3390/ijerph14020175
ParkC.AtiqueM. M. U.MishraR.NajafiB. (2022). Association between fall history and gait, balance, physical activity, depression, fear of falling, and motor capacity: A 6-month follow-up study. International Journal of Environmental Research and Public Health, 19(17), 10785. https://doi.org/10.3390/ijerph191710785
55.
Pettee GabrielK.GriswoldM. E.WangW.ConwayS. H.WindhamB. G.PaltaP.Kucharska-NewtonA.PompeiiL. A. (2019). Physical activity trajectories and subsequent fall risk: ARIC study. Preventive Medicine, 121, 40–46. https://doi.org/10.1016/j.ypmed.2019.02.007
56.
RietdykS.AmbikeS.AmireaultS.HaddadJ. M.LinG.NewtonD.RichardsE. A. (2022). Co-occurrences of fall-related factors in adults aged 60 to 85 years in the United States national health and nutrition examination survey. PLoS One, 17(11), Article e0277406. https://doi.org/10.1371/journal.pone.0277406
57.
RikliR. E. (2000). Reliability, validity, and methodological issues in assessing physical activity in older adults. Research Quarterly for Exercise & Sport, 71(Suppl 2), 89–96. https://doi.org/10.1080/02701367.2000.11082791
58.
RomliM. H.MackenzieL.TanP. J.ChiewR. O.TanS. H.TanM. P. (2021). Comparison of retrospective and prospective falls reporting among community-dwelling older people: Findings from two cohort studies. Frontiers in Public Health, 9, 612663. https://doi.org/10.3389/fpubh.2021.612663
SallisJ. F.CerveroR. B.AscherW.HendersonK. A.KraftM. K.KerrJ. (2006). An ecological approach to creating active living communities. Annual Review of Public Health, 27, 297–322. https://doi.org/10.1146/annurev.publhealth.27.021405.102100
61.
SatarianoW. A.WangC.KealeyM. E.KurtovichE.PhelanE. A. (2017). Risk profiles for falls among older adults: New directions for prevention. Frontiers in Public Health, 5(AUG), 233471. https://doi.org/10.3389/fpubh.2017.00142
62.
SattlerM. C.JaunigJ.TöschC.WatsonE. D.MokkinkL. B.DietzP.van PoppelM. N. M. (2020). Current evidence of measurement properties of physical activity questionnaires for older adults: An updated systematic review. Sports Medicine, 50(7), 1271–1315. https://doi.org/10.1007/s40279-020-01268-x
63.
StahlS. T.AlbertS. M. (2015). Gender differences in physical activity patterns among older adults who fall. Preventive Medicine, 71, 94–100. https://doi.org/10.1016/j.ypmed.2014.12.016
64.
TeasE.FriedmanE.AmireaultS. (2022). Purpose in life and personal growth: The unique and joint contribution of physical activity and basic psychological needs. Applied Psychology: Health and Well-Being, 14(3), 795–818. https://doi.org/10.1111/aphw.12347
65.
TinettiM. E.WilliamsC. S. (1998). The effect of falls and fall injuries on functioning in community-dwelling older persons. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 53(2), M112–M119. https://doi.org/10.1093/gerona/53A.2.M112
66.
TowneS. D.SmithM. L.AhnS. N.AltpeterM.BelzaB.KulinskiK. P.OryM. G. (2015). National dissemination of multiple evidence-based disease prevention programs: Reach to vulnerable older adults. Frontiers in Public Health, 2, 109695. https://doi.org/10.3389/fpubh.2014.00156
67.
VafaeiA.PickettW.ZunzuneguiM. V.AlvaradoB. E. (2018). Relationships between neighborhood social capital and the occurrence of outdoor falls in Canadian older adults: A multilevel analysis. Journal of Aging and Health, 30(7), 1108–1135. https://doi.org/10.1177/0898264317706236
68.
WaldorfB.KimA. (2018). The index of relative rurality (IRR): US county data for 2000 and 2010. Purdue University Research Repository. https://doi.org/10.4231/R7959FS8
69.
WangY.TsaiT. C.DuncanD. T.JiJ. S. (2022). Association of city-level walkability, accessibility to biking and public transportation and socio-economic features with COVID-19 infection in Massachusetts, USA: An ecological study. Geospatial Health, 17(s1). https://doi.org/10.4081/gh.2022.1017
70.
WannerM.Probst-HenschN.KriemlerS.MeierF.BaumanA.MartinB. W. (2014). What physical activity surveillance needs: Validity of a single-item questionnaire. British Journal of Sports Medicine, 48(21), 1570–1576. https://doi.org/10.1136/bjsports-2012-092122
71.
WashburnR. A.McAuleyE.KatulaJ.MihalkoS. L.BoileauR. A. (1999). The physical activity scale for the elderly (PASE): Evidence for validity. Journal of Clinical Epidemiology, 52(7), 643–651. https://doi.org/10.1016/S0895-4356(99)00049-9
72.
WashburnR. A.SmithK. W.JetteA. M.JanneyC. A. (1993). The physical activity scale for the elderly (PASE): Development and evaluation. Journal of Clinical Epidemiology, 46(2), 153–162. https://doi.org/10.1016/0895-4356(93)90053-4
73.
WeinsteinN. D. (2007). Misleading tests of health behavior theories. Annals of Behavioral Medicine: A Publication of the Society of Behavioral Medicine, 33(1), 1–10. https://doi.org/10.1207/S15324796abm3301_1
74.
WhismanM. A.McClellandG. H. (2005). Designing, testing, and interpreting interactions and moderator effects in family research. Journal of Family Psychology: JFP: Journal of the Division of Family Psychology of the American Psychological Association (Division 43), 19(1), 111–120. https://doi.org/10.1037/0893-3200.19.1.111
75.
YzerbytV. Y.MullerD.JuddC. M. (2004). Adjusting researchers’ approach to adjustment: On the use of covariates when testing interactions. Journal of Experimental Social Psychology, 40(3), 424–431. https://doi.org/10.1016/j.jesp.2003.10.001
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
