Active Design for Healthier Affordable Housing: A Public Health Nudge

Background: Most Americans do not meet CDC recommendations for moderate to vigorous (MVPA) and vigorous physical activity (VPA) particularly in urban communities with limited access to PA opportunities. LEED Innovation in Design credit is awarded for Active Design (AD), including enhanced stairwells with stair prompts, delayed elevators and on-site exercise facilities to promote PA.

Purpose: To assess the health impact of living in LEED affordable AD housing compared to residents of similar LEED non-AD housing in the South Bronx, New York.

Methods: At lease-signing and one year later, tenants in new AD affordable housing completed PA self-assessments and trained researchers obtained body measurements. Residents of neighboring affordable housing without AD participated concurrently.

Results: Thirty four adults were recruited from AD and 29 from non-AD buildings, retention was 55% (n=19) and 52% (n=15) respectively at one year. The AD tenants’ BMI and high-risk waist-to-hip ratio (WHR) remained stable over the study period, while non-AD residents increased 6% in overweight and obese BMI and WHR categories. There was a 14% and 13% increase in AD female residents achieving MVPA and VPA recommendations respectively, with no improvements seen in non-AD group. There was a 32% increase in residents that walked up 1-28 flights of stairs per week at home in the AD group compared to 20% increase in non-AD.

Conclusion: This pilot project supports the PA health benefits of AD affordable housing, especially in females, who carry the largest burden of the obesity epidemic in low-income, urban communities.  Broader adoption of AD guidelines is warranted.