Transportation, Land Use, and Community Design

The Transportation, Land Use, and Community Design sector encompasses national, state, tribal, and local organizations, agencies, boards, and governing bodies that address transportation, development patterns, built environment, public spaces, public works, and community design and planning issues.

Table of Contents

  1. Making the case
  2. What can you do?
  3. Strategies
Action Brief

Transportation, Land Use and Community Design Professionals Make a Difference!

 

Making the Case

Arthritis is common and costly

Arthritis is the most common cause of disability in the united states

  • 54.4 million U.S. adults (22.7%) have arthritis.
  • 8.6 million U.S. adults (19%) report disability due to arthritis. In this context, disability is defined as a limitation or loss of function, most often manifested as difficulty climbing a flight of stairs and walking 3 city blocks (a distance equal to walking from the parking lot to the back of a large store or through a mall).
  • As the number of older Americans contin¬ues to grow, and the rates of obesity and overweight increase, the number of people with arthritis will only increase.
To Learn More:

Cheng YJ, Hootman JM, Murphy LB, Langmaid GA, Helmick CG. Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation – United States, 2007–2009. MMWR2010;59(39):1261–1265. html  pdf  [1.61 MB] http://www.cdc.gov/mmwr/PDF/wk/mm5939.pdf

Hootman JM, Brault MW, Helmick CG, Theis KA, Armour BS. Prevalence and Most Common Causes of Disability Among Adults — United States, 2005. MMWR 2009;58(16):421-426. html; pdf  [1.3Mb] http://www.cdc.gov/mmwr/PDF/wk/mm5816.pdf

Arthritis and other rheumatic conditions costs our nation $128 billion each year in health care expenses and lost earnings – or 1.2% of the gross domestic product (in 2003).

To Learn More

Medical care expenditures and earnings losses among persons with arthritis and other rheumatic conditions in 2003, and comparisons with 1997.
http://www.ncbi.nlm.nih.gov/pubmed/17469096?dopt=AbstractPlus

CDC arthritis cost statistics.

Adults with arthritis often have other chronic conditions and arthritis makes managing these other conditions more difficult:

  • Of these comorbid conditions — heart disease (49%), chronic respiratory conditions, obesity (31%), diabetes (47%), and stroke are among the most common
To Learn More

About arthritis comorbidity

About arthritis and anxiety and depression

Adults with arthritis are more likely to fall.

Because of physical limitations and disease progression over time, adults with arthritis are prone to falling. This could be because of pain, awkward gait, tripping or slipping easily, or not being able to “catch” themselves if they are off balance. Engaging regularly in balance activities, such as Tai Chi, has been shown to prevent falls and improve stability.

To Learn More

About Tai-chi

CDC Compendium of Effective Fall Interventions: What Works for Community-Dwelling Older Adults, 2nd Edition

Physical activity benefits all adults — INCLUDING adults with arthritis.

  • It offers immediate and measurable health benefits: decreased pain, delayed onset of disability, and improved physical functioning, mood, and independence.
  • It also enhances quality of life, aerobic capacity, and muscle strength.
  • It is a low-cost, effective, and sustain¬able approach to arthritis management.
To learn more

Arthritis Foundation publications on fitness and nutrition

CDC’s evidence-based physical activity programs for people with arthritis

Kelley GA, Kelley KS, Hootman JM, Jones DL. Effects of community-deliverable exercise on pain and physical function in adults with arthritis and other rheumatic diseases: a meta-analysis. Arthritis Care Res (Hoboken). 2011 Jan;63(1):79-93.
http://www.ncbi.nlm.nih.gov/pubmed/20824798

Zhang W, Nuki G, Moskowitz RW, Abramson S, Altman RD, Arden NK, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P. OARSI recommendations for the management of hip and knee osteoarthritis: part III: Changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage. 2010 Apr;18(4):476-99
http://www.ncbi.nlm.nih.gov/pubmed/20170770

Department of Health and Human Services. Physical Activity Guidelines Advisory Committee Report. Musculoskeletal Health. Available at
http://www.health.gov/paguidelines/Report/pdf/G5_musculo.pdf

Conn VS, Hafdahl AR, Minor MA, Nielsen PJ. Physical activity interventions among adults with arthritis: meta-analysis of outcomes. Semin Arthritis Rheum. 2008 Apr;37(5):307-16.
http://www.ncbi.nlm.nih.gov/pubmed/17888500

Fransen M, McConnell S. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD004376.
http://www.ncbi.nlm.nih.gov/pubmed/18843657

People with arthritis can safely engage in physical activity.

Moderate intensity exercise is safe for people with arthritis due to its low risk of injury, and has been shown not to aggravate joint symptoms. Walking in particular has more than half the risk of musculoskeletal injury compared to other vigorous activities like running. A variety of evidence-based physical activity programs have been tested and proven appropriate and safe for adults with arthritis. Supportive transit systems and built environments allow greater mobility and access to physical activity opportunities.

To Learn More

CDC list of evidence-based physical activity programs for adults with arthritis

Environmental and Policy Approaches to Increase Physical Activity: Transportation and Travel Policies and Practices

Ory M, Resnick B, Jordan PJ, Coday M, Riebe D, Ewing Garber C, Pruitt L, Bazzarre T. Screening, safety, and adverse events in physical activity interventions: collaborative experiences from the behavior change consortium. Ann Behav Med. 2005 Apr;29 Suppl:20-8.

Colbert LH, Hootman JM, Macera CA. Physical activity-related injuries in walkers and runners in the aerobics center longitudinal study. Clin J Sport Med. 2000 Oct;10(4):259-63

Unfortunately, far too few adults with arthritis participate in recommended physical activity.

Adults with arthritis are less likely to be physically active than those without the disease, and this gap widens even further for adults with arthritis who also have diabetes or heart disease or for those who are obese.

To Learn More

National Recreation and Parks Association: 5 Key Trends in Parks and Public Health

Hootman JM, Kamil E. Barbour KE, Watson KB, Fulton JE. State-Specific Prevalence of Walking Among Adults with Arthritis — United States, 2011. MMWR Weekly May 3, 2013 / 62(17);331-334.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6217a3.htm?s_cid=mm6217a3_w

Dunlop DD, Song J, Semanik PA, Chang RW, Sharma L, Bathon JM, Eaton CB, Hochberg MC, Jackson RD, Kwoh KC, Mysiw WJ, Nevitt MC, Hootman JM. Objective physical activity measurement in the osteoarthritis initiative: Are guidelines being met? Arthritis Rheum. 2011 Jul 26. doi: 10.1002/art.30562.
http://www.ncbi.nlm.nih.gov/pubmed/21792835

Barbour KE, Hootman JM, Murphy LB, Helmick CG. Arthritis as a Potential Barrier to Physical Activity Among Obese Adults–United States, 2007 and 2009. MMWR 2011;60(19):614–618.
http://www.cdc.gov/mmwr/pdf/wk/mm6019.pdf

Hootman JM, Barbour KE, Watson KB, Harris C. State-specific prevalence of no leisure-time physical activity among adults with and without doctor-diagnosed arthritis – United States, 2009. MMWR 2011;60(48):1641-1645. http://www.cdc.gov/mmwr/pdf/wk/mm6048.pdf

Bolen J, Murphy L, Greenlund K, , Helmick CG, Hootman J, Brady TJ, Langmaid G, Keenan N. Arthritis as a potential barrier to physical activity among adults with heart disease — United States, 2005 and 2007. MMWR 2009;58(7):165-169.
http://www.cdc.gov/mmwr/PDF/wk/mm5807.pdf

Bolen J, Hootman J, Helmick CG, Murphy L, Langmaid G, Caspersen CJ. Arthritis as a potential barrier to physical activity among adults with diabetes — United States, 2005 and 2007. MMWR 2008;57(18):486-489.
http://www.cdc.gov/mmwr/PDF/wk/mm5718.pdf

Shih M, Hootman JM, Kruger J, Helmick CG. Physical activity in men and women with arthritis National Health Interview Survey, 2002. Am J Prev Med. 2006 May;30(5):385-93.
http://www.ncbi.nlm.nih.gov/pubmed/16627126

What can you do?

“Transportation systems, development patterns, and community design and planning decisions all can have profound effects on physical activity. People can lead healthier, more active lives if our communities are built to facilitate safe walking and biking and the use of public transportation, all considered forms of active transportation.”

Source: The National Physical Activity Plan (http://physicalactivityplan.org/index.html)

A Few Tips

As you think about how best to use your resources and capabilities to make it easier for adults with arthritis to access public transportation and fully utilize community assets, consider the primary environmental barriers they face:

  • Transportation – including lack of transportation to facilities or programs as well as placement of new facilities and programs in locations that are not accessible by public transportation
  • Built environment – including no safe curb cuts (depressed curbs that act as ramps in sidewalks), damaged sidewalks, no sidewalks, terrain, too steep a grade or slope, unsafe neighborhoods, slippery or impassible sidewalks, insufficient number of resting places on streets and trails for people who need frequent rest periods, and poor and/or confusing signage
  • Environmental conditions – congested parking, concrete surfaces, and presence of dogs

Literature reviews and expert interviews reveal several helpful environmental and transit features to overcome major barriers:

  • Pedestrian-oriented designs – continuous, smooth sidewalks, four-way stop signals, adequate street lighting, and other pedestrian amenities support physical activity and reduce obesity. These include walk signals at street crossings that include a countdown with enough crossing time for people who move more slowly and pedestrian refuge islands in the middle of any street crossing that is four or more lanes wide.
  • Barrier-free walkways – curb cuts, smooth pavement, and barrier-free sidewalks can easily prevent mobility disability and promote independence in adults at greatest risk, such as those with underlying weakness in movement-related functions and balance or who use assistive devices.
  • Rest spots – placement of benches and other resting structures, prompt attention to needed repairs, overhangs or “roofs” to shield from inclement weather can make a significant difference for someone who was previously unable to navigate outside independently because of impaired gait or balance or use of an assistive device.
  • Transportation enhancements – services must accommodate persons with disabilities and/or limited mobility and comply with the Americans for Disabilities Act in order to facilitate widespread and universal access to community resources for all people. This includes training of bus drivers and other transport workers to understand and support the needs of adults with arthritis.
  • Crosswalks – at regular intervals with clear signage, auditory and visual prompts, and sufficient time to cross are important for slower walkers. In addition, curb bulbs (sidewalk extensions into an intersection that shorten pedestrian crossing distance) allow pedestrians to be seen by approaching traffic and enable pedestrians to see beyond parked cars.
  • Inclusion of Universal Design features in transportation planning
    • Increase the time both between fare payment and opening of turnstiles and between opening and closing of turnstiles
    • Consider vehicles that have low floors, high ceilings, and wide door openings for easy entering and exiting
    • Complete streets that provide access for all modes of transportation including walking
  • Safety and security features – some approaches relate to road traffic: lower traffic speeds, restricted free right turns, traffic calming around senior centers or senior residences. Others involve emergency call phones in parks and on trails, safety from crime (the more people and eyes on the street, the better) and safety in being able to cross the street without getting stuck in the road (with sidewalks and crosswalks). Safety can be promoted through environmental features such as lighting, but also through community groups including walking groups or law enforcement presence. Walking with a companion is safer than walking alone and has social benefits. Older adults might consider volunteering in safe routes to school programs (for which funding is allocated) that will foster community cohesion and may include facilities improvements like crosswalks.
  • Signage – to indicate when roadways or paths are impassable or under repair. Areas without sidewalks in residential or shopping areas, particularly where there is already significant traffic, may be a deterrent to walking for people with arthritis or physical limitations.
To Learn More

Learn the Truth about Arthritis

Clarke P, Ailshire JA, Bader M, Morenoff JD, House JS. Mobility disability and the urban built environment. Am J Epidemiol 2008;168(5):506-13.

National Association of Area Agencies on Aging. A Blueprint for Action: Developing a Liveable Community for All Ages.
https://www.n4a.org/content.asp?admin=Y&contentid=707

Accessed October 13, 2010:1-74.

Easter Seals Project ACTION
http://es.easterseals.com/site/EcommerceDownload/Universal_Design_FactSheet-5821.pdf?dnl=90752-5821-761N6ivu74JPUrFe

U.S. Department of Labor’s Office of Disability Employment Policy — Disability.gov. Transportation Accessibility Tools and Guidelines.
http://www.dol.gov/odep/resources/JAN.htm

Access Board. Draft revisions to the ADA accessibility guidelines for buses and vans. http://www.access-board.gov/guidelines-and-standards/transportation/vehicles/about-adaag-for-transportation-vehicles

Mitchell C. Pedestrian mobility and safety – A key to independence for older people. Topics in Geriatric Rehabilitation 2006;22(1):45-52.

Rehabilitation Engineering Research Center on Accessible Public Transportation (RERC-APT) at Carnegie Mellon University and the University of Buffalo — Unpublished Data. Cited in “Universal Design & Accessible Transit Systems: Facts to Consider when Updating or Expanding your Transit System”:
Finding Accessible Transportation

Rosenberg DEHuang DLSimonovich SDBelza B.Outdoor built environment barriers and facilitators to activity among midlife and older adults with mobility disabilities. Gerontologist. 2013 Apr;53(2):268-79.

Kerr J, Rosenberg D, Frank L. The Role of the Built Environment in Healthy Aging Community Design, Physical Activity, and Health among Older Adults. Journal of Planning Literature. February 2012;27(1):43-60.

Active Living Research
Crime Prevention and Active Living
National Center for Safe Routes to Schools
California’s Health in All Policies (HiAP) Task Force Implementation Plan for Active Transportation

Strategies

Strategy 1: Examine planning and zoning efforts, such as complete streets and Americans with Disabilities Act (ADA) policies, to ensure that adults with arthritis can walk safely to community centers, workplaces, shopping areas, places of worship, schools, parks, public transportation, and other venues.

Designing neighborhoods and communities with mid-life and older adults in mind will reap positive benefits for all residents, young and old. Being aware of a few relatively simple strategies for providing safe sidewalks, curb ramps, crosswalks, rest stops, benches, walking loops and signage can support physical activity and prevent injuries and falls. State and local planning and transportation boards, authorities, and elected officials should be encouraged to consult with arthritis, aging, and physical activity experts when creating built environments to ensure safety and accessibility for all adults. In addition, the importance of establishing and maintaining green spaces should be reinforced to ensure that people of all ages and abilities have local places to connect and be active.

Tools

Walk Score
America Walks: Resources for Transportation Professionals
America Walks: Resources for Land Use and Planning
CDC Healthy Aging Research Network Environmental Audit Tool and Protocol

Walksteps.org – an interactive online resource aimed at putting innovative pro-walking tactics in the hands of citizens, planners, and engineers. It can help you create your own pro-walking plan, collect your favorite tactic from a range of disciplines, and select the category that interests you and start learning and compiling tactics

CDC’s Community Design web site
The Prevention Institute’s Built Environment and Health: 11 Profiles of Neighborhood Transformation
Making Healthy Places
California’s Health in All Policies (HiAP) Task Force Implementation Plan for Active Transportation

Strategy 2: Use walkability checklists to design and maintain safe and accessible community options for physical activity.

A walking audit (also referred to as a walking assessment) can help examine the walking conditions along specified streets, trails, and paths. They are designed to assess availability, safety, and attractiveness of features that promote walking in a community. They help you map out walkable street segments within neighborhoods, and identify the most common safety hazards and inconveniences that can keep people from walking. Such tools are often the starting point for advocacy efforts; communities start to learn what the barriers are and also have evidence to present to policymakers. They can also help determine where to host evidence-based physical activity programs (such as Walk with Ease) and identify opportunities for environmental change through community engagement.

Tools

National Recreation and Parks Association (NRPA): Walk This Way
NRPA’s Parks Build Healthy Communities: Success Stories
America Walks
Pedestrian and Bicycle Center
Analytic Audit Tool and Checklist Audit Tool
Systematic Pedestrian and Cycling Environmental Scan (SPACES)
Measurement Instrument for Urban Design Quantities Related to Walkability
Pedestrian Environment Data Scan (PEDS) Tool
Path Environment Audit Tool (PEAT)

Strategy 3: Install, upgrade, and maintain sidewalks and benches in new and existing neighborhoods to create safe functional pathways and resting areas in and around parks, recreation centers, and other public venues.

Before venturing into the community to engage in walking or other physical activity, adults with arthritis need to know that there are frequent, safe, and comfortable place for them to rest. Due to pain and/or limitations in endurance and stamina, people with arthritis may need to take frequent breaks from walking to protect their health. Sidewalks with smooth pavement prevent tripping and falling and are also conducive to people who may use assistive devices. Developing a sidewalk inventory can identify where new sidewalks are needed and where older ones need repair. Walking loops can be helpful as well. Furthermore, stores can post signage encouraging older adults to stop by for a rest or bathroom break. These efforts can be reciprocal as older adults may then purchase items along the way.

Samples

NRPA’s Parks Build Healthy Communities: Success Stories
NRPA’s Issue Brief on Creating Safe Park Environments to Enhance Community Wellness
Convergence Partnership’s efforts to strengthen the built environment through transportation and joint use
CDC’s Strategies to Prevent Obesity and Other Chronic Diseases: The CDC Guide to Strategies to Increase Physical Activity in the Community
America Walks