Effects of the rural built environment on older adults engaging in physical activity: A review of the literature

To date there has not been an effort to summarize how the built environment in rural areas affects older adults engaging in physical activity. This paper reviewed 23 studies that have evaluated the rural built environment and its influence on older adults engaging in physical activity. Articles that were included were published from 2000 to the present and included a focus on rural populations. The review included 18 qualitative and five quantitative studies with 17 being cross-sectional, four longitudinal and two quasi-experimental. We examined the study design, sampling techniques, measures of the built environment, measures of rural, results as they relate to rural, and future study implications. In the reviewed literature, there is a relatively limited representation of rural areas with only nine states represented, while four studies used a national sample. Few studies offered a definition of rural and only one study addressed the parameters used to define rural. Thus, the external validity of the majority of reviewed studies is difficult to ascertain. With only four longitudinal studies, this suggests a need for future research to examine the influence of the built environment over time both through seasonal variations and as a person ages. Based on the findings from this review and an examination of physical activity trends for older adults with the 2005 Behavioral Risk Factor Surveillance System, we offer suggestions of regions in the U.S. for future research in this area, improved approaches to assess the rural built environment, and parameters to define rural.