Title: Does active design increase walking and cycling? Evaluation of a natural experiment examining whether moving into housing in East Village increases family levels of physical activity, particularly walking and cycling
Funder: Department of Health and Social Care

Abstract: In the UK, the distances walked and cycled by adults and children have declined over recent years, and in particular the number of journeys made by bicycle both to work and to school are much lower than in other European populations. Although the built environment may be an important influence on physical activity patterns, particularly on uptake of walking and cycling to everyday destinations, there is a dearth of longitudinal evidence. The development of East Village (formerly the Olympic Athletes’ Village) offers a unique opportunity for a longitudinal natural experiment to assess the impact of relocation to a purpose designed walkable urban built environment on walking and cycling patterns. The transformation of East Village into affordable and market rent housing has been carried out on a rapid timescale (ready for occupancy from Autumn 2013), and has been specifically designed to create an environment encouraging walking and cycling and public transport use (with secure bicycle spaces allocated for every home, and restriction of car ownership). This is further enhanced by regeneration of the surrounding area (particularly extension of walkways and cycle paths to the Lee Valley, and connection to the London Cycle Network). The accommodation will be offered to families from a range of widely differing social backgrounds. The rapid transformation will facilitate an assessment of changes in physical activity levels (as well as other health behaviours / outcomes) following relocation to the Village compared with control participants who remain in their original housing. This is a unique opportunity as it (i) represents a natural experiment of people from diverse social backgrounds relocating into a new walkable neighbourhood, and (ii) because most new housing developments take up to a decade to complete. With the support of the NPRI, we are already conducting a two year longitudinal study to evaluate the natural experiment provided by the opening of East Village. One adult and one child from each of 2800 families who apply to live in affordable and market rent homes in East Village are being invited to join a cohort before a formal offer of re-housing is made. In all, 1200 families will be recruited, of which approximately half will move into the Village. Participants will be measured in their current place of residence and then measured again, either in East Village (intervention group) or in their original place of residence (control group). Changes in overall physical activity and body composition (measured objectively using accelerometry and bio-electrical impedance respectively) will be compared between intervention and control groups. The study is powered to detect a 5% increase in the number of daily steps walked (and other activity/adiposity outcomes) in both adults and in children; this represents the lower limit of potentially worthwhile increases in physical activity. The present application extends this study by: (i) evaluating whether movement to an environment with ‘active’ design principles at its heart specifically increases walking and cycling activity; and (ii) quantifying and measuring the design components of East Village and establishing their influence on walking and cycling. We propose to use Global Positioning System (GPS) technology to identify patterns and locations of movement among study participants both within the East Village facility and elsewhere, and to link these personal data with fine-grained environmental data operationalized within a Geographic Information System (GIS) on features of neighbourhood environments of participants before and after moving to the East Village that might promote walking and cycling. Combining the novel GPS data with our established accelerometer data collection will allow us to describe both the level and location of physical activity within the physical environment (including identification of walking and cycling patterns in the intervention and control groups and the extent of change associated with moving to the East Village). It will also allow the segmentation of accelerometer data into that recorded indoors and out of doors, and the objective measurement of time spent outside. Time spent outside is a significant and consistent predictor of children’s physical activity, but until now has been measured poorly, generally by self-report or parent/teacher proxy. The use of GPS data allows a precise measure of time outdoors, and the combination with accelerometer data has allowed us to determine that outdoor physical activity is three-fold higher than indoors. Consequently, a built environment within the East Village that promotes greater independent mobility in children (by providing a safer environment) may be expected to increase time outdoors, and would also be expected to substantially increase young peoples physical activity levels. In combination with novel GIS data, this study we will be able to explore associations between specific features of the built environment (such as walkability, and access to transport and recreational destinations; including green space, purpose built ‘hard’ surfaces) and physical activity. In addition, these data will be used to inform qualitative spatial narratives from participants, which will provide adult and child perspectives on reasons for and purpose of travel. The study offers an important opportunity to examine which, if any, active design principles within a newly build development promotes walking and cycling and increases overall physical activity levels, in individuals (adults and children) from widely different socioeconomic backgrounds; and the differential impact of changes in the built environment on the physical activity patterns of different socioeconomic groups. The results have the potential to inform evidence-based urban planning generally and the design of future higher density urban projects and, particularly in the encouragement of healthier lifestyles in families with varying socioeconomic circumstances. Our established links with the Greater London Assembly, London Legacy Development Corporation, local authorities (particularly Newham), the Town and Country Planning Association, housing associations, urban planners and architects, will enhance the scope for translating study results into policy.

Lay abstract: The number of walking and cycling trips in the UK has been in decline (by approximately one-fifth over the last decade), with UK cycling levels, both in adults and children, amongst the lowest (approximately 2% or less of journeys taken) compared with other European populations. Walking and cycling provides an easy, cheap form of transport, which can easily be part of everyday life, improving health and reducing impact of motorised forms of transport on the environment (CO2 emissions in particular). There is growing cross sectional evidence that where you live has an impact on your health behaviour, particularly your willingness or ability to walk and cycle to everyday destinations. In terms of health inequalities, where we live is often given as a reason for poor health amongst those living in less privileged surroundings. There have been a number of large-scale housing regeneration projects over the years, which aim to improve the living conditions and lifestyles of those living in low cost housing. However, these projects often take a decade or so to complete, making it difficult to demonstrate effects on lifestyle above those taking place over time. Effects of the built environment on physical activity levels, particularly levels of walking and cycling, are of interest as higher physical activity levels have a beneficial impact on a wide range of major chronic diseases. The creation of affordable and market rent housing provided by East Village (available from Autumn 2013) offers a unique opportunity to examine the extent to which relocating to a neighbourhood purpose designed to encourage walking and cycling, affects the uptake of walking and cycling in adults and children. East Village has extensive walking and cycle paths (see http://www.youtube.com/watch?v=HD2evv6AJSE). Walkways include the 6 mile traffic free ‘Greenway’, cyclepaths which extend into the Lee Valley (with 26 miles of parkland) and connect to the London Cycle Network. Recruitment of a cohort of families has commenced, before East Village accommodation becomes available. Families will be followed up over a 2 year period. Physical activity patterns in families (including levels of walking and cycling) before and after moving to the Village, will be compared to those who do not. We will measure how the built environment is used in terms of ease of walking around (walkability), ease of access, convenience of use, and how perceptions of the local environment influence its use, e.g. perceptions of levels of safety, social interactions and cohesion etc. Physical activity patterns are being assessed using accurate movement sensors, body composition is being measured objectively using bio-electrical impedance. This present proposal will add two innovative components: (i) the use of GPS receivers to map patterns of use of the local environment, allowing us to understand what and where activities, particularly walking and cycling, take place; and (ii) accurate mapping of the area using a GIS and remote sensing to investigate whether access to health promoting environmental resources (e.g., cycle paths, walkways, green space, leisure facilities, food retail outlets) influences levels of walking and cycling. An important component of the study will be interviews with both children and adults, which will be used to obtain personal perspectives on reasons for travel. While the short time scale of the intervention is unique, the findings will be generalisable, informing future design of residential developments that are destined to take place elsewhere. It is particularly rare to have the opportunity to study the impact of low income families relocating to a new area which will provide novel and important evidence on optimising outcomes for those most vulnerable. The key to public value of the proposal is that: (i) evidence-based policy requires longitudinal evidence on whether environmental changes, including provision of walkways and cycle paths, positively impacts behaviour; (ii) the cost of evaluations such as that proposed is small compared with the costs of the intervention; (iii) small changes in behaviour distributed widely in the population have the potential to deliver major health benefits; (iv) the magnitude of these benefits can only be identified by carefully designed evaluations of natural experiments such as proposed. Finally we recognize the importance of disseminating our findings. This will be facilitated through our proposed pathway to dissemination, including our stake holder forum which includes policy-makers, practitioners and community members identified by our extensive network of contacts.

Research activity codes: 3.2 INTERVENTIONS TO ALTER PHYSICAL AND BIOLOGICAL ENVIRONMENTAL RISKS
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;METABOLIC AND ENDOCRINE;ORAL AND GASTROINTESTINAL;STROKE