The current study aimed to systematically review the qualitative literature on the physical environment and PA among older adults. We retrieved 31 relevant articles, which varied considerably in setting and methodology. Five environmental themes were identified as potentially influencing older adults’ PA: pedestrian infrastructure, safety, access to facilities, aesthetics, and environmental conditions. Additionally, we obtained detailed in-depth information on how and why the emerging environmental factors influence older adults’ PA.
All included studies described the importance of pedestrian infrastructure. However, in a systematic review of quantitative studies results concerning walking facilities were found to be inconsistent, with the majority of studies yielding a non-significant relationship with PA behaviors . Our findings showed that a variety of sidewalk characteristics might influence their use. For example, participants discussed not only the presence of sidewalks, but also their continuity, slopes and curbs, maintenance, separation from cyclists, etc. Hence, there are many factors influencing the use of sidewalks, which are likely not captured comprehensively in questionnaires used in quantitative studies.
Safety issues, crime- as well as traffic-related, also emerged in almost all qualitative studies as influencing older adults’ PA. In contrast, findings from quantitative studies are equivocal . In the current review, crime- and traffic-related safety emerged as multidimensional constructs, including physical as well as social components. This supports previous calls [56, 57] for more comprehensive measures to assess perceived crime- and traffic-related safety.
Several quantitative studies have consistently reported positive relationships between objective and perceived access to destinations and older adults’ PA behaviors [12–14, 58]. Similarly, older adults in the qualitative studies mentioned easy access to shops, services and senior centers as facilitators of walking and PA. Moreover, they also expressed the need for easy access to public transit. Concerning recreational activity, issues related to the accessibility (e.g., too far away, no transportation) and costs of exercise facilities were frequently noted in the reviewed articles. Participants also expressed a need for age-appropriate forms of PA, including group activities and supervision. Consequently, when studying the relationships between access to PA facilities and older adults’ PA, it might not be sufficient to study merely the presence of general exercise facilities. Our findings suggest that more detailed information about the specific programs offered at the facilities (e.g. provision of age-appropriate group activities) should be included in future studies. Our findings also indicated that informal settings, such as parks, can stimulate older adults’ PA. However, participants were averse to isolated trails in wooded areas with low visibility, possibly due to increased fear of crime . Furthermore, our findings revealed that not only access to different types of destinations was important, but also the presence of resting areas at and on the routes to these destination. The presence of benches, preferably sheltered, was stated to facilitate walking as they provide the opportunity to rest, especially for those with decreased functional capacity. However, two previous quantitative studies reported no significant relationships for transportation walking with objective  and perceived presence of benches . Our qualitative findings might explain this contradiction, as it was shown that not merely the presence of benches might influence older adults’ PA, but also their usability in terms of design (benches easy to sit on for older adults) and accessibility in winter (sheltered benches). These specific details are unique to older adults and reflect the ability of qualitative methods to reveal in-depth information on what, how, and why environmental factors are related to older adults’ PA. Next to benches, the current study also found that the presence of clean washrooms was a potential facilitator of older adults’ PA.
Our findings suggest that aesthetically appealing places, which are well-maintained and include attractive buildings and natural elements, facilitate older adults’ PA. Neglected areas might not only discourage PA for aesthetic reasons, they might also increase fear from crime and, therefore, inhibit older adults’ PA . However, the majority of previous quantitative studies reported no relationship between aesthetics and older adults’ PA behaviors . Possibly, as was proposed by Alfonzo , the aesthetic appeal of a place might be a less important theme when compared to pedestrian infrastructure, access to facilities, or safety, and might only come into play when the environment is already generally favorable for PA (e.g., safe places with high-quality sidewalks and easy access to facilities). Participants also preferred unpolluted areas that provide fresh air over areas with car exhaust fumes and traffic noise. Furthermore, the participants’ statements reflected seasonal effects. Participants preferred the comfortable warmth of spring time as opposed to the heat of the summer or the cold, snow, ice, and darkness of winter.
Findings of the reviewed qualitative studies add depth and detail to the results of previous quantitative research. Our findings suggest that a more comprehensive assessment of certain environmental factors in quantitative studies might lead to a more accurate understanding of environment-PA relationships in older adults. The qualitative studies highlight the importance of micro-scale environmental characteristics (e.g., quality of sidewalk and presence of benches), which might be especially relevant for older adults’ PA, but which have not been linked consistently to older adults’ PA in previous quantitative studies. However, most studies included in our review employed focus groups and/or individual interviews, while only a few studies employed spatial qualitative methods. These spatial qualitative methods are especially useful in understanding the physical environment from the informants’ perspectives. This is particularly essential among older adults, who develop unique environmental needs due to age-related changes (decreased functional capacity, impaired sight or hearing, etc.). Although our comparison between themes revealed by interview versus spatial methods was rather preliminary, it did illustrate the added value of spatial qualitative methods. It showed that themes, which reflected unique environmental needs of older adults (e.g. access to resting areas), were frequently reported in studies using spatial methods. Combining individual or focus group interviews with spatial methods in future research can add depth to our understandings of PA-environment relationships by connecting specific objective environmental attributes to the subjective experiences of informants.
In the reviewed studies, most of the individual and focus group interviews were conducted according to predetermined guidelines that focused on either the physical environment or PA, while only a few focused on both the physical environment and PA. Consequently, the findings of these studies focused primarily on the informant’s views on either the physical environment (e.g., perceived walkability) or PA (e.g., PA barriers and facilitators). Future qualitative studies should include guidelines that include both descriptions of the physical environment and PA.
Some limitations of the current review should be acknowledged. First, we made no distinction between different PA domains. There are several reasons for this; many different types of physical activities were studied in the reviewed articles, some articles did not explicitly define the physical activities targeted, and in the Results sections findings for different physical activities were often mixed up. Hence, future qualitative studies should explicitly define which PA behavior(s) they targeted. This also requires that qualitative researchers should provide clear instructions to their participants regarding which activities to consider during data collection. Secondly, only two of the included articles used member checking as a way to validate the researchers’ interpretation of data against the participants’ intended meanings. The use of member checking should be encouraged in future qualitative studies. A primary strength of the current study is the comprehensive search in multiple databases reflecting the multidisciplinary nature of the topic. Moreover, we used the summarized qualitative information to complement and explain inconsistencies observed in previous quantitative research.
To conclude, this review provided an overview of the characteristics and findings of qualitative studies in the research area of environment-PA relationships in older adults. Additionally, we observed some discrepancies in emerging environmental factors and themes between interview-based and spatial qualitative methodologies. Based upon the reviewed qualitative studies, in order to promote PA among older adults, environments should (1) provide high-quality pedestrian infrastructure, (2) be safe from crime and traffic, (3) provide easy access to exercise opportunities, daily destinations and rest areas, (4) be aesthetically appealing, and (5) provide pleasant environmental conditions. Our findings showed that qualitative research can provide in-depth information on not only which, but also how and why environmental factors influence older adults’ PA. It was shown that it is not just the mere presence of an environmental attribute (e.g. a sidewalk), but also its quality (e.g. continuity, evenness, maintenance, separation), that should be taken into account when designing environments that aim to stimulate PA among older adults. This finding might also explain previously observed inconsistencies between quantitative studies. Hence, future quantitative studies should not only take into account the presence of certain environmental attributes but also their quality. From a methodological perspective, given the interdisciplinary nature of our topic, including both the physical environment and PA in interview guidelines and combining interviews with more spatially-oriented methods may provide a fuller and more nuanced description of environment-PA relationships. Good examples of such interdisciplinary collaborations can already be found in quantitative studies, which combine geographic measurements (e.g., GIS and environmental audits) with health data (e.g., accelerometer-derived and self-reported PA and functional capacity) [13, 14, 61, 62]. Therefore, mixed-methods studies, including both quantitative and qualitative methods, may provide a good platform for interdisciplinary collaborations that can result in establishing quantitative relationships complemented with in-depth qualitative information.