Walkable Neighborhoods May Reduce Risk of Developing Prediabetes

Residents in easily walkable neighborhoods, compared to car-dependent neighborhoods, were less likely to develop prediabetes after a one year follow up.

With Jacob Kariuki PhD, Amy Hess-Fischl MS, RD, LDN, BC-ADM, CDE and Ghazal Fazli PhD

A mother walks in her neighborhood with two kidsA recent study found that people that lived in walkable neighborhoods were less likely to develop prediabetes.

The easier it is to walk in a neighborhood, the lower the chances the residents will develop prediabetes, according to new research. 

Over a year's observation, the risk of having prediabetes was 17% lower in the participants from walkable neighborhoods than in the participants from car-dependent neighborhoodshowever, after adjusting for income levels, people in walkable neighborhoods were at a 73% lower risk.

Not surprisingly, those in walkable neighborhoods were more likely to get other forms of physical activity, too. "Individuals who resided in walkable neighborhoods had three times greater odds of attaining the recommended moderate to vigorous physical activity (MVPA) at 12 months compared to those from car-dependent neighborhoods," says Jacob Kariuki PhD, assistant professor at the University of Pittsburgh School of Nursing, who presented the research at the American Diabetic Association's 81st Scientific Sessions.

Study Details

This research was a secondary analysis of the EMPOWER study, using prospective observational 12-month weight loss data collected from participants enrolled in behavioral weight loss intervention. The EMPOWER study recommended people get more than 22 minutes a day of moderate-to-vigorous physical activity (MVPA). 

Researchers determined the neighborhood walkability using an algorithm provided by Walk Score (Seattle, WA). The walkability score ranges from 0-100, with 100 being the least walkable neighborhood. For this study, they split neighborhoods into “car-dependent” (scores >=50) and “walkable” (scores <50).  Of the 114 people included in the final analysis, 73 lived in car-dependent neighborhoods and 41 in walkable ones.

At baseline, there were no significant differences between those from car-dependent or walkable neighborhoods. Participants were mostly women and mostly white. Average age was 51.5 years. The average weight was 92.6 kilograms. Most participants were well-educated, with nearly 76% having four or more years of college.  The average physical activity (PA) at baseline was just 12 minutes a day, well below the recommended 22 minutes a day in the original study. At baseline, 35.6% in the car-dependent neighborhoods and 24.4% in the walkable neighborhoods were prediabetic. 

At the 12-month mark, physical activity and glucose control were improved for all, with no differences found between neighborhoods. Overall, the walkability did not improve the chances of attaining the 22-minute MVPA goal (OR=1.16, 0.97-1.39).  However, overall, those people in the walkable neighborhoods had a lower incidence of prediabetes, 17% as reported in the abstract. 

Dr. Kariuki says, "In our initial analysis which informed the abstract, we could not pinpoint the key driver of this association. However, in subsequent analyses where we controlled for participants’ household income, we were able to demonstrate that residing in walkable neighborhoods greatly increased the chances of attaining the recommended physical activity goal at the end of the studyby as much as 73%. We believe that increased physical activity could be one of the factors that may explain our study findings."

Supporting Research

The findings echo those of other studies. For instance, University of Toronto researchers looked at the records of 1.1 million adults, 20 to 64, who had normoglycemia between January 2011 and December 2011. All were residents of one of 15 cities in Southern Ontario. Participants were grouped into 10 categories from lowest walkability locations to highest.

Overall, more than 220,000 (~20%) developed prediabetes during a median follow up of 8.4 years, according to the study researcher Ghazal Fazli PhD, an assistant professor at the University of Toronto. As in the study presented at ADA, Dr. Fazli’s group found that prediabetes incidence was reduced in highly walkable areas for most groups living in Southern Ontario cities, but that was accompanied by ethnic differences as well. 

She says, "The extent to which neighborhood walkability can lower risk of prediabetes is complex to disentangle. In our study, we found that living in a walkable neighborhood was associated with a lower incidence of prediabetes, but this was not the case for all ethnic groups in our study. " For example, in Asian communities the association was reversed, with those living in highly walkable neighborhoods at greater risk of developing prediabetes. 

Second Opinion

"Based on the Diabetes Prevention Program, we know two major things impact glucose, weight and risk reduction for prediabetes: reducing calories in their diet and walking at least 30 minutes a day. For populations who live in areas where they cannot walk outside or do not have a treadmillor they are not willing to exercisewe see an increase in risk," says Amy Hess-Fischl MS, RD, LDN,BC-Adm, CDE, a certified diabetes educator and transitional program coordinator for the Kovler Diabetes Center in Chicago, who reviewed the findings.

Suggestions for Clinicians

The bigger question, Hess-Fischl says, is how to motivate people to do the recommended amount of physical activity. She suggests clinicians ask their patients these questions to help encourage those who aren't living in walkable neighborhoods:

  • Is it safe to walk up and down the stairs of your apartment?
  • Could you walk in place while watching TV?
  • What about trying free exercises offered on some TV channels?
  • How can you be more active?

"This [discussion] has to be patient-centered," Hess-Fischl says. "The person should decide what they can successfully set as a goal. It is all about movement and you can do that anywhere."

Lastly, Dr. Kariuki says, "While we cannot make clinical recommendations based on our limited analysis, there is a growing body of evidence suggesting the need for clinicians to consider their patients’ environment when they are coming up with recommendations for lifestyle modification. Knowledge about a patient’s neighborhood walkability could help a clinician come up with practical recommendations for increasing physical activity that may better reflect each patient’s living situation."

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