diabetes atlas for the region of peel - chapter 6 ... · of diabetes. areas of lowest physical...
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Chapter6
Opportunities for Physical activity & DiabetesinsidE
Highlights
Introduction
List of Exhibits
Exhibits and Findings
Discussion
Conclusions and Implications
Appendix 6.A – Research Methodology
References
autHors
Jane Y. Polsky
Jonathan T. Weyman
Maria I. Creatore
Anne-Marie Tynan
Peter Gozdyra
Richard H. Glazier
Gillian L. Booth
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HigHligHtsissue• Regularphysicalactivityisessentialforthe
preventionandmanagementofdiabetes.Despitedecadesofpubliccampaignstopromotephysicalactivity,levelsofactivityintheCanadianpopulationremainlow.
• Researchersandplannersrecentlybegantodirectattentiontotherolethatneighbourhoodopportunities,suchasparksandrecreationcentres,playinfosteringphysicalactivity.
• Thepurposeofthischapteristoexaminethedistributionofandaccesstoparks,schoolsandrecreationfacilitiesacrossPeel.Thischapteralsopresentslevelsofleisure-timephysicalactivityundertakenforrecreationorexercisepurposes,andassociatedprevalenceratesofdiabetes.
Key Findings• Accesstoparksandschoolswasgenerally
goodandsimilaracrossresidentialareasinPeel.However,thedensityofparkareavariedsignificantly.InmanyareasofMississaugaandcentralBrampton,residentshadrelativelylittleparkareapercapita(comparedwiththerestofPeel)andwerefarfromalargerparkspace.Thismaybedue,inpart,toashiftindesignfromsmallerneighbourhoodparkstofewer,larger“destination”parkfacilities.
• Publicrecreationfacilitiesweremuchlessevenlydistributed.Becausemanyfacilitieswereclusteredincertainlocations,localresidentshadverygoodaccesstoanumberofdifferentfacilities,whilemanymoreresidentsofotherareaswerefarfromanyrecreationfacility.
• Therewasnoclearspatialcorrespondencebetweenaccesstoparks,schoolsandrec-reationfacilities,andratesofdiabetesorphysicalactivity.
• AbouthalfofPeelresidentswereatleastmoderatelyphysicallyactiveduringtheirleisuretime.LevelsofphysicalactivitywerehighestinpartsofMississaugaandCaledon;
theywerelowestamongresidentsofeastCaledon,BramptonandcentralandnortheastMississauga.
• Levelsofphysicalactivitywererelatedtoratesofdiabetes.Areasoflowestphysicalactivitygenerallyhadthehighestratesofdiabetesandmanyareaswithhigherlevelsofphysicalactivityhadlowerratesofdiabetes.
implications • InPeel,levelsofphysicalactivityweregener-
allyunrelatedtohowcloseresidentslivedtophysicalactivityresources.Thisimpliesthatgoodspatialaccesstorecreationresourcesmaynotbeenoughtoencouragelocalresidentstobemorephysicallyactive.
• Creativeinitiativestoincreaselevelsofphysi-calactivitywillbeveryimportantgiventherelativelylowlevelsofactivityinthegeneralpopulationandahighproportionofresidentsathighriskofdiabetesduetotheirethnicbackground.Evensmallincreasesindailylevelsofactivitycanplayalargeroleinde-creasingtheriskoftype2diabetes,particularlyamonghigh-riskindividuals.
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• GiventherapidlygrowingpopulationinPeelandrisingratesofdiabetes,itisessentialthatvariouslevelsofgovernment,urbanplannersandhealthofficialsworktogethertocreateampleopportunitiestosupportandencouragehigherlevelsofdailyphysicalactivityamongPeelresidents.
• Thehealthneedsandtheethnoculturalpreferencesoflocalpopulationsubgroups,aswellastheexistingavailabilityofappropriateresources,shouldbeconsideredwhenpoliciesandprogramsthatsupporthealthylivingarecreated.
introductionPhysical activity and HealthPhysicalactivityplaysanessentialroleinpreventingmanychronicdiseases,particularlycardiovasculardisease,type2diabetesandsomecancers.1Asmanyasoneinfivediagnosesoftype2diabetesinCanadamaybeduetoinadequatelevelsofphysicalactivity.2
Mostpeopleknowthatphysicalactivityhelpstomaintainahealthybodyweight.Maintainingahealthybodyweight,inturn,helpstopreventthedevelopmentofchronicdiseases.Itisalsoimpor-tanttoknowthatbeingphysicallyactivehasanindependenteffectonhealth–fortwopeopleofthesamebodyweight,themorephysicallyactivepersonwillhavealowerriskofdiseasethanthepersonwhoislessphysicallyactive.3,4
Thetermphysicalactivityencompassesavarietyofactivitiesthatpeopleundertakeeitherforutilitarianpurposes(i.e.,physicalactivitythatoccursathome,atworkorduringtravel,suchaswalkingtogetsomewhere)orforrecreationorexercisepurposesduringleisuretime(e.g.,playingbasketballorjogging).Formostpeople,themajorityoftheirdailyactivitiesfallintothefirstcategory.
How physically active are canadians?NewinternationalandCanadianphysicalactivityguidelinesrecommendthatadultsshouldaccumulateatleast150minutesofmoderate-to
vigorous-intensityphysicalactivityaweek,inboutsof10minutesormore,inordertoachievehealthbenefits.5MostCanadiansdonotachievesufficientlevelsofactivitydespitedecades-longeffortstopromotephysicalactivityinthegeneralpopulationwithmasseducationalcampaignslikeParticipACTION.In2007–09,only15%ofadultsreachedtherecommendedlevelofactivity.6Menwereconsistentlymoreactivethanwomenandlevelsofphysicalactivitydeclinedwithadvancingageandincreasingbodyweight.Mostindica-torsoffitness,includingflexibilityandmusclestrength,declinedbetween1981and2007–09,particularlyamongyoungadultsaged20to39.7
Forchildrenandyouth,regularphysicalactivityisessentialforhealthygrowthanddevelopment–themoreactiveayoungperson,thegreaterthehealthbenefits.Canadianguidelinesrecommendthatchildrenandyouth(betweenfiveand17yearsofage)accumulateatleast60minutesofmoderate-tovigorous-intensityphysicalactivityeveryday.5In2007–09,only7%ofchildrenandyouthattainedtheserecommendedlevelsofphysicalactivity.8Boysweremoreactivethangirls,with9%ofboysandonly4%ofgirlsachiev-ingtherecommendedlevelsofactivity.
Physical activity and diabetes Inadequatelevelsofphysicalactivitycancausedecreasedsensitivitytoinsulinandglucoseintolerance–bothofwhichareimportantfactorsinthedevelopmentandcontrolofdiabetes.9,10Inindividualsathighriskfortype2diabetes(i.e.,thosewithimpairedglucosetoleranceorpredia-betes),evensmallincreasesinlevelsofphysicalactivityhavethepotentialtosignificantlyslowdownorpreventtheprogressiontotype2diabetes.9,11Participationinregularphysicalactivityandchangesindietplayessentialrolesinreducingtheoccurrenceoftype2diabetesinhigh-riskgroupsbyasmuchas60%.12
Forindividualslivingwithdiabetes,regularphysicalactivity,dietandmedicationplaykeyrolesinoptimallymanagingthisconditionandpreventingcomplications.Regularphysicalactivityhelpstoreducetheriskofcardiovasculardisease,othercomplicationsandprematuredeath
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amongthoselivingwithdiabetes.10,13Asaresult,ClinicalPracticeGuidelinespublishedbytheCanadianDiabetesAssociationrecommendthatadultswithdiabetesundertakeregularaerobicactivity(i.e.,atleast150minutesofmoderate-tovigorous-intensityactivity,suchasbriskwalkingorjogging,aweek),aswellasresistancetrainingexercisesthreetimesaweek.10
Theamountoftimedevotedtosedentarybe-haviourslikesittingforlongperiodsorwatchingtelevision–independentofaperson’slevelsofphysicalactivityanddiet–candirectlyincreasetheriskofobesity,type2diabetesandprematuredeath.4,14,15Thesefindingsareofgreatconcerngiventhatin2007–09,mostCanadianadultsandyoungpeoplespentthemajorityoftheirwakinghoursinsedentaryactivities.6,8Toaddressthesetroublingtrends,Canadianexpertsrecentlydevelopedaseparatesetofguidelinesspecifictosedentarybehaviourforchildrenandyouth.16Theseguidelinesrecommendthatchildrenandyouthlimitnotonlytheamountofleisuretimetheyspendinfrontofascreentonomorethantwohoursaday,butalsothetimetheyspendsittingincarsandindoorsthroughouttheday(sedentarybehaviourguidelinesforCanadianadultsarenotcurrentlyavailable).
Physical activity and the EnvironmentLevelsofphysicalactivitydependnotonlyonanindividual’spropensitytobeactive,butalsoonthesurroundingphysicalenvironment.Forexample,livinginsuburbancommunitieshasbeenassociatedwithagreaterrelianceoncars,lowerlevelsofwalkingandhigherlevelsofover-weight/obesitycomparedwithlivingincompactcities.17-19(foradetaileddiscussionaboutfeaturesofneighbourhooddesignrelatedtowalkingandbicyclingfortransportation,seeChapter5).Inadditiontourbandesignfeatureslikethepres-enceofsidewalksandnearbyshopsandservices,goodaccesstoparksandrecreationcentresclosetohomealsoplaysaroleindeterminingthedura-tionandfrequencyofphysicalactivity.20-22Forinstance,adultswholivednearmoreparkswithinonekilometreoftheirhomeinWaterloo,Ontarioweremorelikelytomeetphysicalactivityrecom-mendationsbywalking,bicyclingorengaginginothertypesofphysicalactivityinnearbyparksorelsewhereintheneighbourhood.23Eachad-ditionalhectareofparklandnearhomewasalsorelatedtohigherlevelsofmoderate-to-strenuousphysicalactivityundertakenwithinanearbypark.
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Betteraccesstoneighbourhoodopportunitiesforphysicalactivityisoftenrelatedtohigherlevelsofactivityamonglocalresidents,buttheseassociationsarenotalwaysconsistent.Rather,activitypatternsvarybytypeofneighbourhoodamenity,howresearchersmeasureaccessandbytypeofphysicalactivity.Outdoorspaces,includ-ingtrails,openspaces,golfcoursesandnaturalsettings(e.g.,beaches),aremorestronglyrelatedtolevelsofvarioustypesofphysicalactivity(i.e.,leisure-timeorutilitarian)amonglocalresidentsthanindoorsettingssuchasrecreationcentresandexerciseandsportsfacilities.21Proximityseemstoplayamoreconsistentrole;livingclosertoparksandvariousrecreationsettingswasassociatedwithincreasedlevelsofvarioustypesofphysicalactivity.Goodaccesstoparksandrecreationsettingsismorecommonlyrelatedtophysicalactivityforexerciseandutilitarianpurposes–mostcommonly,walking–ratherthanforrecreation.22
Neighbourhoodamenitiesmayalsoplayaroleinhowactivechildrenandyouthare.Childrenweremoreactiveifparentsfelttheyhadgoodaccesstorecreationfacilitiesandspaceswithintheirneighbourhood.24-26Forexample,childrenlivinginNovaScotianeighbourhoodswithbetteraccesstoplaygrounds,parksandrecreationfacilitiesweremoreengagedinstructuredsportsactivities,hadlesstelevisionandvideogametime,andhealthierbodyweights.25InLondon,Ontario,youthaged11to13livingnearmorepublicrecreationopportunitiessuchasswim-mingpools,parks,recreationcentresandbikepathsweremorephysicallyactivethanyouthwhoseneighbourhoodscontainedfewerofsuchamenities.26
diabetes and the Environment Investigationoflinksbetweenthephysicalenvi-ronmentanddiabetesisarelativelynewareaofstudy.InthreedifferentareasoftheUnitedStates(U.S.),adultswholivedinneighbourhoodswithbetteraccesstoopportunitiesforphysicalactivity–suchasparksandtrails–werelesslikelytohaveinsulinresistancethanresidentsofareaslessfriendlytophysicalactivity.27Thefactthatadults
wholivedinthemoreactivity-friendlyareasweremorephysicallyactiveaccountedforsomeofthisassociation.Adultswholivedinneighbourhoodswithbetterresourcesforphysicalactivityandhealthyeatingwerelesslikelytodeveloptype2diabetesduringafive-yearperiodcomparedwiththosewholivedinneighbourhoodswithworseaccesstosuchresources.28
Neighbourhoodsthatmakeiteasyforresidentstobephysicallyactiveonadailybasisarealsoimportantforpeoplelivingwithdiabetes.Adultslivingwithtype2diabetesinAlbertawhofeltthattheirneighbourhoodsweremore“walkable”(e.g.,withmanyshopsandlow-costrecreationfacilitieswithina10-to15-minutewalkfromhome)weremorelikelytoachievetherecom-mendedlevelsofphysicalactivitybywalkingmorefrequentlytogettoandfromplaces.29
Inthischapter,geographicaccesstoseveralopportunitiesforphysicalactivityacrossPeelisexamined.Easyaccesstophysicalactivity
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orresourcesisimportantbecauseitmayen-couragelocalresidentstousetheseresourcesmorefrequently,aswellasuseactivemeansoftransportation(i.e.,walkingorbicycling)toreachthesevenues.Ratesofphysicalactivityundertakenforleisure(i.e.,forrecreationorexercisepurposes,andnotrelatedtowork)andtheprevalenceofdiabetesareexamined.Inthischapter,ameasureofphysicalactivityderivedfromtheCanadianCommunityHealthSurvey,whichaskedrespondentsabouttheirparticipationinvariousleisure-timeactivitiessuchaswalkingforexercise,gardeningoryardwork,bicycling,playingbasketball,orjoggingorrunning,wasused.Becausethesurveyquestioninvolvedtherespondents’owninterpretationofwhatconsitututesleisuretime,somepeople’sresponsesmayhaveincludedsomeamountofactivetransportation,suchaswalkingorbicy-clingtogettoandfromplaces.Unfortunately,intheseanalyses,aseparatemeasureoflevelsofutilitarianphysicalactivity(includingactivetransportation)amongPeelresidentswasnotavailable(seeChapter5foraveragewalkingandbicyclingtripsinPeel,whichareproxymeasuresofactivetransportation).Finally,thespecificresourcesforphysicalactivityunderstudyinthischapterincludeschools,parksandpublicrecreationfacilitiessuchascommunityrecreationcentresandsportsarenas.Whilenoteveryresourceissuitableforalllocalresidents,togethertheyconstituteanimportantsourceofindoorandoutdooropportunitiesforphysicalactivityforcommunities.
list oF ExHiBitsExhibit 6.1Locationsofparks[2009]andschools[2009]inPeelregion
Exhibit 6.2Parkareainsquarekilometres(sqkm)[2009]per10,000population[2006],bycensustract[2006],inPeelregion
Exhibit 6.3Parks[2009]andschools[2009]per10,000population[2006],bycensustract[2006],inPeelregion
Exhibit 6.4Locationsofpublicrecreationfacili-ties[2010]inPeelregionandadjacentareas*
Exhibit 6.5Locationsofprivaterecreationfacilities[2010]inPeelregionandadjacentareas*
Exhibit 6.6Publicrecreationfacilities(includ-ingcommunitycentres,arenasandswimmingpools)[2010]per10,000population[2006],bycensustract[2006],inPeelregion
Exhibit 6.7Modelledtraveldistancealongtheroadnetwork[2009]tothenearestlocationofapark[2009]orschool[2009],inPeelregion
Exhibit 6.8Modelledtraveldistancealongtheroadnetwork[2009]tothenearestlocationofapublicrecreationfacility(includingcommunitycentres,arenasandswimmingpools)[2010],inPeelregion
Exhibit 6.9Spatialrelationshipbetweentheaverageroadnetworkdistancetothenearestpark[2009]orschool[2009]andage-andsex-standardizeddiabetesprevalenceratio-ratios*[2007],bycensustract[2006],inPeelregion
Exhibit 6.10Spatialrelationshipbetweentheaverageroadnetworkdistancetotherecreationfacility[2010]andage-andsex-standardizeddiabetesprevalenceratio-ratios*[2007],bycensustract[2006],inPeelregion
Exhibit 6.11.Age-andsex-standardizedrateofmoderate-to-highphysicalactivity*inleisuretimeper100peopleaged12+[2003–08]andage-andsex-standardizeddiabetesprevalenceratesper100personsaged20+[2007],byPeelHealthDataZone(PHDZ)[2006],inPeelregion
Exhibit 6.12.Age-andsex-standardizedrateofhighphysicalactivity*inleisuretimeper100peopleaged12+[2003–08]andage-andsex-standardizeddiabetesprevalenceratesper100personsaged20+[2007],byPeelHealthDataZone(PHDZ)[2006],inPeelregion
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ExHiBits and Findings
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10
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C A L E D O N
B R A M P T O N
Findings:
•
•
La k e O n t a r i o
Schools were generally well distributedacross residential areas. Only small pockets oflimited availability were found across the region,particularly in northeast Brampton and in southMississauga north of the QEW.
Larger park areas were located in north Caledon, north and east Brampton, and central and west Mississauga (along the Credit River).Many smaller parks were scattered throughout the region.
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C A L E D O N
B R A M P T O N
M I S S I S S A U G A
Locations of parks and schools
Residential AreaOther Land Use
Park or Recreational Area
School (primary or secondary)
Census Tract Boundary
Municipal Boundary
Industrial Area
Freeway or Highway
International Airport
0 5 10 km
0 2.5 5 km
Exhibit 6.1. Locations of parks [2009] and schools [2009] in Peel region
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410
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Findings:
• More park area per capita was concentrated in north Caledon, outlying areas of Brampton and along the Credit River in Mississauga.
La k e O n t a r i o
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403
401
QEW
427
409
Park area in sq. km per 10,000 population
0.0 – 0.50.6 – 1.01.1 – 2.02.1 – 5.05.1 – 25.4
Census Tract Boundary
Municipal Boundary
Industrial Area
Freeway or Highway
International Airport
0 5 10 km
0 2.5 5 km
Exhibit 6.2. Park area in square kilometres (sq km) [2009] per 10,000 population [2006], by census tract [2006], in Peel region
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Findings:
•
•
The majority of census tracts throughout Peel had 10 or more parks and schools per 10,000 population.
A number of census tracts in east Caledon, central andsouthwest Brampton, and various parts of Mississauga had lower concentrations of parks and schools (compared with the rest of Peel).
La k e O n t a r i o
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401
QEW
427
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Parks and schools per10,000 population
0.0 – 5.05.1 – 10.010.1 – 20.020.1 – 40.040.1 – 80.1
Census Tract Boundary
Municipal Boundary
Industrial Area
Freeway or Highway
International Airport
0 5 10 km
0 2.5 5 km
Exhibit 6.3. Parks [2009] and schools [2009] per 10,000 population [2006], by census tract[2006], in Peel region
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Findings:
•
•
La k e
O n t a r i o
Public recreation facilities were fairly widely distributed across Peel’s residential areas. A larger number of facilities were concentrated in central Brampton compared with the rest of Peel.
A few pockets of residential areas in northeast Brampton and in parts of Mississauga lacked a nearby public recreation facility.
* Some facilities in areas adjacent to Peel are not shown on this map to improve readability. These adjacent locations were included in the analyses shown in Exhibits 6.8 and 6.10.
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Public Recreation Facility,Community Centre orSports Centre
Recreation/CommunityCentre, Pool and Arena
Swimming Pool or AquaticCentre
Arena
Locations of public recreation facilities
Residential AreaOther Land Use
Census Tract Boundary
Municipal Boundary
Industrial Area
Freeway or Highway
International Airport
0 5 10 km
0 2.5 5 km
Exhibit 6.4. Locations of public recreation facilities [2010] in Peel region and adjacent areas*
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Findings:
•
•
La k e
O n t a r i o
Private recreation facilitieswere clustered in east Caledon(near Bolton), central Brampton andin several portions of Mississauga. Theywere generally located along major roads andoutnumbered public recreation facilities (Exhibit 6.4).
In Brampton and Mississauga, many private recreationfacilities were concentrated within or near industrial areas.
* Some facilities in areas adjacent to Peel are not shown on this map to improve readability.
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Locations of private recreation facilities
Private Recreation Facility(e.g., gym, health club,martial arts, yoga studio)Golf or Country Club
Horseback Riding Facility
Sailing Club
Arena
Residential AreaOther Land Use
Census Tract Boundary
Municipal Boundary
Industrial Area
Freeway or Highway
International Airport
0 5 10 km
0 2.5 5 km
Exhibit 6.5. Locations of private recreation facilities [2010] in Peel region and adjacent areas*
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Findings:
•
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La k e O n t a r i o
Certain neighbourhoods in northwest Caledon, west and central Brampton, and central and southeast Mississauga had the highest density of public recreation facilities per capita (compared with the rest of Peel).
A much larger number of census tracts throughout Peel had few or no facilities per capita. However, most of these areas had a relatively high density of parks and schools (Exhibit 6.3).
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Public recreation facilities per10,000 population
0.01.0 – 2.02.1 – 4.04.1 – 6.06.1 – 10.3
Census Tract Boundary
Municipal Boundary
Industrial Area
Freeway or Highway
International Airport
0 5 10 km
0 2.5 5 km
Exhibit 6.6. Public recreation facilities (including community centres, arenas and swimmingpools) [2010] per 10,000 population [2006], by census tract [2006], in Peel region
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Findings:
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•
La k e
O n t a r i o
In central Brampton and throughout Mississauga, most neighbourhoods had good access along the street network to a park or school (1,000 metres or less).
Distance to the nearest park or school appeared to be longer (2 km or more) in most areas of Caledon, outlying areas of Brampton and in some parts of Mississauga (particularly along the major highways). However, most of these areas were non-residential (e.g., rural, undeveloped or commercial areas).
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QEW
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Modelled distance (m) to nearest park or school
501 – 1,0001,001 – 2,000
0 – 500
2,001 – 5,0005,001 – 8,009
Census Tract Boundary
Municipal Boundary
Industrial Area
Freeway or Highway
International Airport
0 5 10 km
0 2.5 5 km
Exhibit 6.7. Modelled travel distance along the road network [2009] to the nearest location of a park [2009] or school [2009], in Peel region
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Findings:
•
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•
La k e
O n t a r i o
Most residents of Peel did not live within walking distance of the nearest recreation facility. Residents of many portions of Mississauga, outlying areas of Brampton, and south and northeast Caledon were at least 2 km away from the nearest recreation facility.
However, a number of areas scattered throughout Peel had relatively good access to a public recreation facility (within 1,000 metres or less).
Access to recreation facilities was poorer than access to parks and schools, particularly in Mississauga and in southwest and northeast Caledon (Exhibit 6.7).
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Modelled distance (m) to nearest public recreation facility
501 – 1,0001,001 – 2,000
0 – 500
2,001 – 5,0005,001 – 15,179
Census Tract Boundary
Municipal Boundary
Industrial Area
Freeway or Highway
International Airport
0 5 10 km
0 2.5 5 km
Exhibit 6.8. Modelled travel distance along the road network [2009] to the nearest location of a public recreation facility (including community centres, arenas and swimming pools) [2010], in Peel region
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Findings:
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•
La k e
O n t a r i o
A small number of neighbourhoods innortheast Brampton and adjacent to thelarge industrial area in northeast Mississauga hadhigh rates of diabetes (at least 20% higher than the GTA)and were located relatively far from a park or school.However, most high-diabetes areas in these cities had verygood access to parks and schools.
In south Mississauga, several adjacent areas with lower rates of diabetes(at least 20% below the GTA) had very good access to the nearest park or school.
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Diabetes Rate-ratio*
66 3,8491,000500
≥ 1.20
≤ 0.80
0.81 – 1.19
Avg. distance (m) tonearest park or school
DIABETESHIGH
*Rate-ratio calculated as:
Overall Greater Toronto Area (GTA) diabetes rate: 9.0%
census tract rate for pop. aged 20+GTA rate for pop. aged 20+
Census Tract Boundary
Municipal Boundary
Industrial Area
Freeway or Highway
International Airport
0 5 10 km
0 2.5 5 km
Exhibit 6.9. Spatial relationship between the average road network distance to the nearestpark [2009] or school [2009] and age- and sex-standardized diabetes prevalence rate-ratios* [2007], by census tract [2006], in Peel region
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Findings:
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•
La k e
O n t a r i o
A number of high-diabetes neighbourhoods (with rates at least 20% higher than in the GTA) in central and northeast portions of Brampton and Mississauga were located far (2 km or further) from a public recreation facility.
However, residents of many other high-diabetes areas in these cities lived within medium or close proximity of a public recreation facility.
Some areas in north and west Caledon and in south Mississauga had both lower rates of diabetes (at least 20% below the GTA) and long distances to the nearest recreation facility.
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Diabetes Rate-ratio*
627 9,7852,0001,000
≥ 1.20
≤ 0.80
0.81 – 1.19
Avg. distance (m) tonearest public rec. facility
DIABETESHIGH
*Rate-ratio calculated as:
Overall Greater Toronto Area (GTA) diabetes rate: 9.0%
census tract rate for pop. aged 20+GTA rate for pop. aged 20+
Census Tract Boundary
Municipal Boundary
Industrial Area
Freeway or Highway
International Airport
0 5 10 km
0 2.5 5 km
Exhibit 6.10. Spatial relationship between the average road network distance to the nearest public recreation facility [2010] and age- and sex-standardized diabetes prevalence ratio-ratios* [2007], by census tract [2006], in Peel region
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49.3
32.6
Findings:
•
•
La k e
On t a r i o
Self-reported levels of physical activity were lowest in east Caledon (near Bolton) and in northeast and southwest Brampton. Only about a third of residents in these areas reported being at least moderately active.
With the exception of east Caledon, PHDZs with lower levels of physical activitycorresponded to areas with high rates of diabetes.
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49.3
47.4
47.4
43.2
45.3
45.335.5
49.4
34.1
48.2
47.3
54.4
56.7
48.355.9
42.7
Moderate-to-high physical activity* rate per 100 aged 12+
32.6 – 40.040.1 – 45.045.1 – 50.050.1 – 56.7
*Levels of physical activity equivalent to walking 30 to 60 minutes a day or more.
Diabetes rate per 100 aged 20+
7.1 – 9.19.2 – 10.9
11.0 – 12.9
Peel Health DataZone (PHDZ) Boundary
Municipal Boundary
Industrial Area
Freeway or Highway
International Airport
0 5 10 km
0 2.5 5 km
Exhibit 6.11. Age- and sex-standardized rate of moderate-to-high physical activity* in leisure time per 100 people aged 12+ [2003–08] and age- and sex-standardized diabetes prevalence rates per 100 persons aged 20+ [2007], by Peel Health Data Zone (PHDZ) [2006], in Peel region
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27.320.1
Findings:
•
•
•
La k e
On t a r i o
Across Peel, the proportion of residents who reported high levels of physical activity during leisure time was generally low but varied considerably across PHDZs from about 15 to 30 per 100 people.
Levels of physical activity were highest in most parts of Mississauga and Caledon.
Especially low activity rates were reported in Brampton (particularly in the southwest and northeast portions), in east Caledon, and in central and northeast Mississauga. Except for east Caledon, these regions corresponded to areas with high rates of diabetes.
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27.3
23.0
23.0
21.4
22.5
22.515.2
28.0
28.4
14.6
25.9
25.9
27.9
23.929.6
23.5
High physical activity* rate per 100 aged 12+
14.6 – 20.020.1 – 25.025.1 - 29.6
*Levels of physical activity equivalent to walking an hour a day or jogging for 20 minutes a day.
Diabetes rate per 100 aged 20+
7.1 – 9.19.2 – 10.9
11.0 – 12.9
Peel Health DataZone (PHDZ) Boundary
Municipal Boundary
Industrial Area
Freeway or Highway
International Airport
0 5 10 km
0 2.5 5 km
Exhibit 6.12. Age- and sex-standardized rate of high physical activity* in leisure time per 100 people aged 12+ [2003–08] and age- and sex-standardized diabetes prevalence rates per100 persons aged 20+ [2007], by Peel Health Data Zone (PHDZ) [2006], in Peel region
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discussion
Availability of Parks, Schools and Recreation SpacesParks and schools Parksystems(e.g.,schoolparks,cityparksandparkettes,conservationareas,provincialparks)arepopularrecreationdestinationsforPeelresidents.Theyservenotonlylocalresidents,butalsopeoplewholiveoutsidetheneighbourhood.Largeparksoftenserveadifferentpurposefromlocal,smallgreenspaceslocatedwithincommu-nities.30Largeparksarefrequentlythelocationforcommunity-basedfairs,picnics,walks,bicycleroutesandsportingevents.Smallergreenspacesaretypicallyusedaschildren’splaygroundsandfordog-walking.30
Sincemostschoolshaveyardsorplaygroundsthatarereadilyaccessibletothegeneralpublic,theycanalsoserveasimportantlocalsettingsforresidentstoengageinlightorvigorousphysicalactivity.30Peelschoolsweredistributedfairlyevenlythroughouttheregionwiththegreatma-jorityofschoolslocatedinsideresidentialzones.
ParksandschoolswerefairlyevenlydistributedthroughoutresidentialareasinPeel.However,parkareapercapitavariedsignificantly:anumberofareasalongtheCreditRiverandinsouthMississauga,infringeareasofBramptonandinnorthCaledonhadrelativelyampleparkareapercapita.However,inmanyotherareasofPeel,particularlyaroundMississaugaCityCentre,inwest,eastandnortheastMississauga,andthroughoutcentralBrampton,residentshadrelativelylittleparkareapercapitacomparedwithotherareasofPeel.Thismaybedue,inpart,toashiftinurbandesignfromsmallerneigh-bourhoodparkstofewer,larger“destination”parkfacilities.Nonetheless,therelativelylowdensityofparkspercapitainsomeareasofPeelisanimportantfindingsincepeoplelivinginmoredenselypopulatedneighbourhoodswithlittleornopersonalgreenspacesuchasbackyardsorgardens(particularlyresidentsofapartmentbuildings)maydependmoreonnearbyparksforexerciseandoutdooractivity.
Parksettingscanincludeavarietyoffeaturessuchaspavedtrails,bicyclepaths,opengreenspaceandplaystructures.InOntario,parksizeandthenumberofparkfeatureswereamongthestron-gestpredictorsofadultsusingaparkforphysicalactivity.23,31Sincesmallerparkstendtolackavarietyoffacilities(e.g.,trails,woodedareas),residentsofcentralBramptonandMississaugawholivefarfromlargerparkareasmaylackaccesstopublicoutdoorsettingsthatmoststronglysupportavarietyofphysicalactivities(e.g.,walking,runningorbicyclingalongparktrails).Unfortunately,nodataonparkfeaturesandamenitiesinPeelwereavailableforanalysis.
Public and private recreation facilities Publicrecreationfacilitiesplayanimportantanddistinctroleinsupportingphysicalactivityandprovideimportantsettingsforresidentstoparticipateinorganizedsports.30Privatefacilities(i.e.,thosenotoperatedbylocalmunicipalities)maynotbefinanciallyaccessibletoallmembersofthegeneralpublic;nonetheless,theyserveasimportantandpopularsettingsforindividualsandfamiliestotakepartinavarietyofphysi-calactivities.Bothprivateandpublicindoorfacilitiesareparticularlyimportantlocationsforpeopletoexerciseandplaysportscomfortablyduringthewintermonths.30
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Intheseanalyses,avarietyofpublicrecreationfacilities,includingcommunityorsportscentres,swimmingpoolsandarenas,wereexamined.ThesefacilitieswerewidelydistributedacrossPeel’sresidentialareaswithsomeclusteringoffacilitiesinseveralpocketsofcentralBramptonandinpartsofMississauga.Thisclusteringoffacilitieswasreflectedinthehighlyvarieddensityoffacilitiesper10,000population–whilemostcensustractsinPeelcontainednorecre-ationfacilities,afewcensustractsincentralandnorthwestCaledon,westandcentralBrampton,andsoutheastMississaugahadupto10differentfacilitiesper10,000residents.However,mostareaslackingpublicrecreationfacilitieshadrela-tivelygoodaccesstoparksandschools,whichforsomeresidentsmayatleastpartiallycompensateforthelackofnearbyindoorrecreationalspaces.
Thelocationsofprivaterecreationalfacilities,in-cludinggyms,healthclubs,martialartsandyogastudios,hockeyandsoccerclubs,golfcoursesandhorsebackridingfacilities,acrossPeelwerealsoexamined(foramorecomprehensivelistoffacilities,pleaseseeAppendix6.A).Manyprivatefacilitieswerelocatednearpublicrecreationfacilities(e.g.,intheBoltonarea,withindown-townBramptonandinsouthMississauga)andalongmajorroads.Anumberofprivatefacilities
wereconcentratedwithinornearnon-residentialareas(e.g.,industrialorcommercialareas).
geographic access to Parks, schools and Public recreation Facilities Publicaccesstothenearestparkorschool(measuredusingmodelledtraveldistancealongtheroadnetwork)wasgenerallyverygoodthroughoutPeel’sresidentialareas.Inmostresidentialareas,thenearestschoolorparkwaslessthan500metresaway.Thisrepresentsarangeofdistancesthatmostpeoplecanwalkinlessthansevenminutes.Thereareasmallnumberofareaswithsomewhatworseaccesstothenearestparkorschool(within1,000morfurther),particularlyalongHighway403andtheQEWinMississauga,andinoutlyingareasofBrampton.DespitethegenerallyshortdistancestoschoolsandparksacrossPeel,therewasnoinformationaboutwhichmodeoftransportationresidentscommonlyusetoaccessthesere-sources(e.g.,walkingordriving).Becauseofthelargelysuburban,car-orientedlayoutofmanyPeelneighbourhoods(e.g.,lackofsidewalksonbothsidesofthestreet;wideroadswithhighspeedlimitswhichcreateconcernsabouttrafficsafetyforpedestrians),itispossiblethatmanyresidentsrelyoncarsorschoolbusestoaccessnearbyamenities.
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Accesstopublicrecreationfacilitiesfollowedadifferentpatternfromaccesstoparksandschools.BecauseofthemuchsmallernumberofsuchfacilitiesinPeelcomparedwithparksorschools,aswellastheirclusteringincertainlocations,onlyafractionofresidentialareashadrelativelygoodaccesstopublicrecreationfacili-ties(within1,000morless,whichcorrespondstoabouta14-minutewalkorless).ThismeansthatthegreatmajorityofPeelresidentslivedtwokilometresorfurtherfromthenearestpublicrecreationfacility(whichrepresentsabouta30-minutewalkeachway).Thisisaconcerningfindingbecauseitrepresentsalackofpublicrecreationfacilitiesnearwheremostpeoplelive.Longdistancestorecreationfacilitiesmaydiscourageresidentsfromaccessingsuchfacilitiesbyactivetransportorfromaccessingthematall.
diabetes rates and geographic access to Parks, schools and Public recreation Facilities ManyareasofBramptonandnortheastandcentralMississaugahadhighratesofdiabetesamongtheirresidents(seeChapter2).Manyoftheseneighbourhoodshadahighproportionoflowereducation,lowerincomeandvisibleminorityresidents(seeChapters3and4).
Proximitytoparksandschoolsdidnotappeartohaveastrongassociationwithpatternsofdiabe-tesprevalence.Whileasmallnumberofcensustracts(innortheastBramptonandadjacenttotheairportinMississauga)hadworseaccesstoparksandschools(atleast1,000maway),themajorityofareaswithhighratesofdiabetesamongtheirresidentswerelocatedlessthan500mawayfromthenearestparkorschool.AnumberofareasinsouthMississaugawithlowerratesofdiabetesamongtheirresidentsalsohadverygoodaccesstoparksandschools.
Similartoparksandschools,therewasnoob-servedspatialconcordancebetweengeographicaccesstopublicrecreationfacilitiesandratesofdiabetes.ThismaybedueatleastinparttoalowlevelofvariationinaccesstothesefacilitiesacrossPeel(i.e.,mostareaswerelocatedrelativelyfarfromapublicrecreationfacility).Withthe
exceptionoffourcensustractsinBramptonandnortheastMississauga,themajorityofhigh-diabetesareaswerelocatedrelativelyfarfromthenearestpublicrecreationfacility.InBrampton,mostareaswithhighratesofdiabetesamongtheirresidentswerelocatedatleast1,000mawayfromapublicrecreationfacility(atleasta14-minutewalkeachway),whilemanyotherswereatleast2,000maway(atleasta30-minutewalkeachway).InMississauga,roughlyhalfofallhigh-diabetesareashadmoderatelylongtraveldistances(1,000to2,000m)andhalfhadevenlongerdistancestotheseresources.Similarly,themajorityoflowerdiabetesareasinCaledonandsouthMississaugaalsohadrelativelylongtraveldistancestothenearestpublicrecreationfacility.However,theselowerdiabetesareasaregenerallycomprisedofhigherincomepopulationsthatmaybelessdependentonlocalandlowercostpublicrecreationfacilities.
TherearefewpublicrecreationfacilitieswithinwalkingdistanceofwheremostresidentsofPeellive.ThismeansthatmostPeelresidentsprobablyneedtodriveacartoaccessapublicrecreationfacility.Havingsuchfacilitieswithinwalkingdistance(alongwithothercommondestinationssuchasshopsandservices)mayencourageroutinephysicalactivityforutilitar-ianpurposes(e.g.,walkingtogettoandfromplaces).22,29Thisisanimportantpointbecauseutilitarianactivityisthemostimportantsourceofphysicalactivityinthegeneralpopulation.Additionally,livingincloseproximityofa
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recreationfacilitymaybeespeciallyimportantforprovidingacomfortablespacetobephysicallyactiveinaclimatelikeCanada’swithlong,coldwinters–particularlyforfamilieswithyoungchildrenandolderpeople.
Physical activityAbouthalfofPeelresidentsreportedbeingmoderately-to-highlyphysicallyactiveduringleisuretime(equivalenttowalking30to60minutesadayormore),andaboutaquarterreportedhighlevelsofactivity(equivalenttojog-ging20minutesorwalkinganhouraday).Theselevelswereverysimilartobothprovincialandnationalaverages.32Despitetheoverallsimilarity,therewasalotofvariationinlevelsofactivityacrossPeelHealthDataZones.TheproportionofresidentswhowereatleastmoderatelyorhighlyactivewashighestinwestandsouthMississauga,andinCaledon(exceptineastCaledon).ResidentsofBramptonandeastCaledon(nearBolton)generallyreportedthelowestlevelsofphysicalactivityintheregion.ResidentsofnortheastandcentralMississaugaalsoreportedlowerlevelsofphysicalactivity.Withtheexcep-tionofeastCaledon,thesewerethesameareasthatalsohadhighratesofdiabetesprevalenceamongtheirresidents(9.6%orhigher).
Althoughmanyhealthorganizationsrecommendaccumulatingatleast150minutesofmoder-ate-tovigorous-intensityphysicalactivityperweekforoptimalhealthbenefits,thereisgrowingevidencethatevenlowerlevelsofactivityprovideimportanthealthbenefits.Just15minutesofmoderate-intensityactivityaday(e.g.,briskwalking)significantlyreducedtheriskofprema-turedeathinmenandwomenofvariousages,aswellasinpeopleathighriskforcardiovasculardisease.33Thisisimportantforindividualswhoarecurrentlyinactive–increasingactivitylevelsbyasmallamountismuchmorefeasiblethanimmediatelyachievinghighlevelsofphysicalactivity.Thishasimportantimplicationsfordevelopingprogramsandmessagestoincreaselevelsofroutinephysicalactivityinthegeneralpopulation(e.g.,tofacilitatehigherlevelsofdailywalkingorbicyclingfortransportation).
SeparateratesofphysicalactivityformenandwomeninPeelwerenotavailable.However,men(particularlyyoungerandoldermen)aremorelikelytoparticipateinleisure-timephysicalactivitiesthanwomenofsimilarage.32Otherindividual-levelfactorsrelatedtobeinglessphysicallyactiveincludeolderage,lowersocioeconomicstatus,beinganimmigrantandnon-Whiteethnicity.32,34Anadditionallimitationoftheseanalysesisthemeasurementofonlyonetypeofphysicalactivity(i.e.,physicalactivityduringleisuretime),whichrepresentsaportionofaperson’stotaldailyactivity.Whilesomepeoplewhoareinactiveduringtheirleisuretimemaybesufficientlyactiveduringnon-leisurehours(e.g.,duringworkhours)toderivehealthbenefits,mostpeoplewhoareinactiveintheirleisuretimearealsolessactiveinotheraspectsoftheirlives.32Finally,therewerenodataonlevelsofsedentaryactivities(e.g.,sittingforlongperiods).Sedentaryactivitiesincreasetheriskofchronicdiseaseandprematuredeathindepen-dentofaperson’slevelsofphysicalactivity.4,14,15
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Incontrasttothestrongspatialcorrespondencebetweenratesofphysicalactivityanddiabetes,therewasnoclearspatialrelationshipbetweenaccesstoparks,schoolsorpublicrecreationfacilities,andratesofphysicalactivity.Thatis,ratesofphysicalactivitywerenotconsistentlylowerinareasthathadworseaccesstosuchphysicalactivityresources,norwereactivityratesconsistentlyhigherinareaswithbetteraccesstotheseresources.Thissuggeststhatotherfactorsbesidesspatialproximitytoplacestobephysi-callyactivemaybemoreimportantinshapingindividuals’patternsofactivity.ComparedwithWhites,allimmigrantandethnicminoritygroups(exceptAboriginals)inCanadareportedlowerlevelsofoverallphysicalactivityandwerelesslikelytoparticipateincertaintypesofactivi-ties,includingwalking,enduranceactivities(e.g.,jogging,swimming)andsports(e.g.,basketball,icehockey).34However,thesamegroupsweremorelikelytoparticipateinmoreconventionalformsofexercisesuchashome-basedexerciseandaerobicsclasses.
Ethnoculturalcharacteristicsmayalsoinfluencewhetherapersonisawarethatlocalrecreationfacilitiesexistandknowsofthevariouspro-grams/amenitiestheyoffer.PatientsofSouthAsianbackgroundwithcoronaryheartdiseaseweremuchlessawareofanyfacilitiesforphysicalactivitynearwheretheylivedcomparedwithWhitepatients;theywerealsomorelikelytohavediabetes.35Suchresultshighlightthefactthatgeographicaccesstorecreationspacesdoesnotnecessarilyequalaccessasindividualsperceiveit.Thisisaninherentlimitationofmostmeasuresofgeographicaccessthatreadersmustkeepinmindwheninterpretingtheresultsoftheseandsimilaranalyses.
conclusions and iMPlications Beingphysicallyactiveiscriticalforbothpre-ventingandmanagingdiabetes.Limitedaccesstoplacestobephysicallyactivecanposearealobstacletoachievingadequatelevelsofactiv-ityrequiredtoachievehealthbenefits.Inthis
chapter,theavailabilityofandaccesstovariousrecreationresourcesacrossPeel,aswellasratesofdiabetesandleisure-timephysicalactivityamongPeelresidents,wereexamined.
ParksandschoolsweregenerallywelldistributedacrossPeel’sresidentialareas.Mostresidentslivedwithinlessthana10-minutewalkofthenearestparkorschool.Incontrast,accesstolargerparkspaces(whichmaysupportphysicalactivitymorestronglythansmallerparks)andpublicrecreationfacilitieswaslesseven,withthemajorityofresidentsnotlivingwithinwalkingdistanceofsucharesource(whichmayhinderuse).LandusepatternsinPeelthatseparateresidentialareasfromallothertypesoflandusesmayberesponsibleforsomeofthesetrends.Inareaswhereaccesstorecreationresourcesispoor,communityprogramsandotherinitiativestoencouragepeopletobemoreactivemaybeineffectiveandinsufficientifresidentscannoteasilyaccessappropriatespacesandfacilities.
Theanalysesintheatlasshownoclearcor-respondencebetweenaccesstopublicrecreationspacesandratesofdiabetesorphysicalactivity.Thismaybedue,atleastinpart,toalowlevelofvariationinaccesstothesefacilitiesacrossPeel(i.e.,mostareaswerelocatedrelativelyfarfromapublicrecreationfacility).Thesefindingsalsohighlightthefactthattheexistenceofrecreationresourcesinaneighbourhooddoesnotensurethatresidentswillactuallyusetheseresources.30Itiscertainlynotonlythespatialproximitytoaresource,butalsotheaesthetics,designandsafetyofrecreationspaces,andculturalandsocialfactors,thatinfluencewhetherpeoplewillusearesource.34-36Thus,inareaswherethereisgoodaccesstoparksandrecreationfacilities,healthpromotersshouldfocusonincreasingresidents’awarenessthattheseresourcesexistandonovercominganysocial,environmentalandculturalbarrierstotheiruse.AcrossPeel,population-wideeffortstoincreaseresidents’awarenessoftheimportanceofachievingoptimallevelsofphysicalactivityforhealthwillalsocontinuetobeveryimportant.
Overalllevelsofleisure-timephysicalactivityself-reportedbyPeelresidentswereverysimilar
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totheprovincialandnationalaverages.However,activitylevelsvariedconsiderablyacrosstheregion:residentsofeastCaledon,BramptonandportionsofcentralandnortheastMississaugareportedthelowestlevelsofactivity.Thisisofgreatconcernbecausethemajorityoftheseareasarealsohometoalargeproportionofresidentsbelongingtoethnicgroupsthathaveageneticpredispositiontodevelopingtype2diabetesatayoungerageandlowerbodyweight(seeChapter4foramoredetaileddiscussionofethnicityinrelationtodiabetes).
Healthpromotioninitiativesmustconsiderethnoculturalfactorswhendesigninginterven-tionstoincreaselevelsofphysicalactivityamongPeelresidents,particularlyforthoseathighriskofbeingphysicallyinactiveandofdevelopingchronicdisease.Forexample,programsdesignedtotargetspecificethnoculturalorimmigrantsubgroupsinPeelmayincludeconsultationwithlocalresidentstofindoutwhichtypesofphysicalactivitythesegroupsprefer.34
aPPEndix 6.a – rEsEarcH MEtHodologyData sources
Parks, schools and recreation facilities • Dataonparklocationsandparkareasin2009
wereobtainedfromtheRegionofPeel.Thefollowingcategoriesofparkswereincluded:schoolparks(includingprivateschools),conservationareas,forestmanagementareas,cityparksandparkettes,andprovincialparks.Inthesedata,someparkswererepre-sentedasmultipleadjacentpolygons.Theseadjacentpolygonswereaggregatedandparkboundariesweregeneralizedtoreducethecomputationalpowerrequiredforanalysis.Intotal,1,134parksranginginsizefrom89squaremetresto4.6squarekilometreswereincludedintheseanalyses.
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• TheRegionofPeelsupplieddataonallpublicandother(e.g.,Catholic)schoolsfor2009,whichtotaled425.Fourschoolsinthesedataweremarkedasclosedandwerethusremoved,leaving421schoolsthatwereincludedintheanalyses.
• TheRegionofPeelprovideddataonpublicrecreationfacilitiesintheregionin2010.Thesefacilitiesincludedcommunitycentres,recre-ationcentres,indoorandoutdoorswimmingpools,arenas,artificialicerinks,gymnasiumsandsportscentres,soccerfieldsandtenniscourts.Therewassomeoverlapbetweenspacesofrecreationandparks,sincemanysoccerfieldsarelocatedwithincityparks.
• Thelocationsof416privaterecreationfacilities(i.e.,facilitiesnotoperatedbylocalmunicipali-ties)in2010wereobtainedfromaproprietarycommercialdatabase(Dunn&Bradstreet,Inc).Thesefacilitiesincludedprivateathleticsclubsandgyms,healthclubs,martialartsandyogastudios,golforcountryclubs,curlingclubs,racquetballandsquashclubs,tennisclubs,ice-skatingandin-lineskatingrinks,swimmingclubs,gymnasticsclubs,soccerandhockeyclubs,horsebackridingfacilitiesandsailingclubs.Althoughthesefacilitiesarenotuniversallyaccessible,theirlocationswereincludedintheanalysesbecausetheymayservetofillingapsinpublicfacilities’services,especiallyinhigherincomeneighbourhoods.
• Fordensityofresourcesper10,000populationbycensustract,the2006CanadianCensuswasusedtoderivethetotalpopulationwithineachcensustract.
diabetes Prevalence • Age-andsex-standardizeddiabetesprevalence
ratesper100peoplewerecalculatedusingtheOntarioDiabetesDatabase(ODD)andotheradministrativedatasourcesheldattheInstituteforClinicalEvaluativeSciences(ICES)(seeAppendix2.Aforamoredetaileddescription).
• Inordertoremoveanyinfluenceduetodifferencesinthepopulation’sageandsex
distributionacrosscensustractsorPeelHealthDataZones(PHDZs),theratesofdiabetesprevalencewerestandardizedtothe1991CanadianCensuspopulation.
Physical activity • Dataonself-reportedphysicalactivityduring
leisuretimeamongPeelresidentsage12oroldercamefromStatisticsCanada’sCanadianCommunityHealthSurveys(CCHS).DuetothesizeandsamplingoftheCCHS,levelsofphysicalactivitycouldnotbereportedbycensustract;instead,thelargerPHDZswereused.Inordertoreachanadequatesamplesize,CCHScycles2003(Cycle2.1),2005(Cycle3.1)and2007/2008werecombinedusingstatisticalmethodsthattakeintoaccountthesurveydesignandweightingtechniques.
• Todeterminelevelsofphysicalactivity,thederivedvariable“LeisureTimePhysicalActivityIndex”intheCCHSwasused.Thisindexcategorizesrespondentsasbeing“active”,“moderatelyactive”or“inactive”basedonthetotalamountofenergy–inkilocaloriesperki-logramofbodyweight–thateachrespondentexpendsonanaverageday.Thistotalenergyexpenditurewasestimatedfromallactivitieslastingmorethan15minutesthatrespondentsreportedengaginginduringtheirleisuretimeoverthepreviousthreemonths.TodeterminepatternsofphysicalactivityamongPeelresi-dents,theproportionofallrespondentswhowereclassifiedaseitheratleastmoderatelyactiveoractivewascalculated.Individualsclassifiedasmoderatelyactiveusedbetween1.5and3kilocaloriesperkilogramofbodyweightperday(e.g.,walking30to60minutesadayorengaginginthree,hour-longexerciseclassesperweek).32Individualsclassifiedasactiveused3ormorekilocaloriesperkilogramofbodyweightperday(e.g.,walkinganhouradayorjogging20minutesaday).32
• Inordertoremoveanyinfluenceduetodifferencesinthepopulation’sageandsexdistributionacrosscensustractsorPHDZs,thephysicalactivityrateswerestandardizedtothe1991CanadianCensuspopulation.
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• StatisticsCanada’sspecificguidelinesforreportingestimatesbasedonCCHSdatawasfollowed(seeAppendix2.Aformoredetailsaboutthesereportingguidelines).SeparateratesofphysicalactivityinmenandwomenwerenotreportablebecauseofthelargecoefficientofvariationinmanyPHDZsforthesex-specificrates.
analysisTheavailabilityandaccessibilityofparks,schoolsandpublicrecreationfacilitiesacrossPeelregionwasexamined.Availabilitywasdepictedintwowaysonmapsincludedinthischapter:
• Thefirstmethodusedsymbolstoshowthelocationsofresources(e.g.,recreationfacilitiesacrosstheregion).Thismethodprovidedanopportunitytodeterminewhereserviceswerelocatedandwhethercertainresourcesexistedinspecificneighbourhoods.
• Thesecondmethodusedchoropleth(shaded)mapstoshowthedensityofresourcesineacharea,takingpopulationintoaccount(i.e.,thenumberofrecreationfacilitiesper10,000residents).Thismethodidentifiedwhereresoureswerelocatedinrelationtowherepeoplelivedandwhichneighbourhoodshadmoreresourcespercapitathanothers.
Access/accessibility,asshownontheaccessibilitymaps,wasmeasuredastheshortestdistance(alongthestreetnetwork)fromeachpointacrossPeelregionina150-metregridofstartingpointstothenearestresourcelocation(e.g.,thedistancealongthenetworkofstreetsandhighwayslead-ingtoarecreationcentre).
Thespatialrelationshipbetweentheaccessibil-itymeasuresandratesofdiabetesprevalencethatwereeithermuchhigher(20%ormore)ormuchlower(20%orless)thantheGTAaveragediabetesrate(9%)werealsoevaluated.ForeachPeelcensustract,thediabetesratewasdividedbytheoverallGTArateinordertocalculatearate-ratio.CensustractswithdiabetesratesthatweremeaningfullyhigherthanintheGTAasawhole(rate-ratioof≥1.2)weredepictedinshadesofred,whiletractswithratesmuchlowerthan
intheGTA(rate-ratioof≤0.80)weredepictedinshadesofblue.AllcensustractswhoseratesdidnotdiffersubstantiallyfromtheGTArate(rate-ratiobetween0.81and1.19)weredepictedusingasinglegreycolour.
Finally,theaveragerateofleisure-timephysi-calactivityineachPHDZwasdepictedusingshaded(choropleth)maps.Associatedratesofage-andsex-standardizeddiabetesprevalenceineachPHDZwereoverlaidonthismapus-ingproportionalsymbols(circles).Thethreecategoriesofdiabetesprevalencewerederivedfrompopulation-weightedtertilesofPHDZs(i.e.,allPHDZswereorderedfromlowesttohighestdiabetesprevalenceandthendividedintothreegroupswithequalpopulations).Thismethodwasusedtocreateareasonabledistributionofratesacrossthesmallnumberoftheserelativelylargespatialunits.
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