The impact of psychiatric facility design on reducing aggressive behaviours in an adult population: a narrative literature review.

OBJECTIVES: This review examines the literature to determine whether physical design features of psychiatric facilities can help reduce aggressive behaviours in an adult patient population. METHODS: Using PRISMA's methodology, we conducted a narrative review of peer-reviewed primary studies on the physical design features and aggressive behaviours in psychiatric facilities. The Joanna Briggs Institute's (JBI) critical appraisal tool was used to assess the quality of included studies. RESULTS: A total of eight studies were identified. The findings revealed underlying themes in physical design efforts to reduce the incidences of aggressive behaviours, which included changes in structural design (e.g. single rooms; visiting/living/recreational areas; views of outdoors/nature; and uncrowded spaces) and changes in interior design (e.g. art and home-like/comforting environment). There were varying measures of patient aggression. CONCLUSIONS: There was mixed evidence that superficial or structural design changes to psychiatric wards reduced patient aggression. Some studies found reduced aggression; others found no changes, while one study found increased aggression following the implementation of physical design changes. The methodological limitations of the available studies made it difficult to draw causative links and further research on the topic is needed.

Stroke Inpatient Rehabilitation Environments: Aligning Building Construction and Clinical Practice Guidelines Through Care Process Mapping.

BACKGROUND: Stroke inpatient rehabilitation is a complex process involving stroke survivors, staff, and family utilizing a common space for a shared purpose: to optimize recovery. This complex pathway is rarely fully described. Stroke care is ideally guided by Clinical Practice Guidelines, and the rehabilitation built environment should serve to optimize care delivery, patient and staff experience. We aimed to articulate the inpatient stroke rehabilitation process of care in a series of process maps, and to understand the degree to which current stroke clinical and building construction (ie, design) guidelines align to support inpatient stroke rehabilitation. METHODS: We used the Value-Focused Process Engineering methodology to create maps describing the events and activities that typically occur in the current stroke inpatient rehabilitation service model. These maps were completed through individual and group session consultations with stroke survivors, architects, policy makers, and clinical experts. We then determined which sections of the Australian Stroke Rehabilitation Guidelines and the Australasian Health Facility Design Guidelines could be aligned and applied to the process maps. RESULTS: We present a summary process map for stroke inpatient rehabilitation, alongside detailed process maps for 4 different phases of rehabilitation (admission, a normal weekday, a weekend day, and discharge) using Value-Focused Process Engineering notation. The integration of design and clinical guidelines with care pathway maps revealed where guidelines lack detail to be readily linked to current stroke inpatient care practice, providing an opportunity to design stroke inpatient rehabilitation spaces based on the activities occurring within them. CONCLUSIONS: Our findings highlight gaps where clinical and design experts should work together to use guidelines to their full potential; and to improve the process of planning for future stroke rehabilitation units.

Implementing a new birthing room design: a qualitative study with a care provider perspective.

BACKGROUND: Research shows that interventions to protect the sensitive physiological process of birth by improving the birthing room design may positively affect perinatal outcomes. It is, however, crucial to understand the mechanisms and contextual elements that influence the outcomes of such complex interventions. Hence, we aimed to explore care providers' experiences of the implementation of a new hospital birthing room designed to be more supportive of women's birth physiology. METHODS: This qualitative study reports on the implementation of the new birthing room, which was evaluated in the Room4Birth randomised controlled trial in Sweden. Individual interviews were undertaken with care providers, including assistant nurses, midwives, obstetricians, and managers (n = 21). A content analysis of interview data was conducted and mapped into the three domains of the Normalisation Process Theory coding manual: implementation context, mechanism, and outcome. RESULTS: The implementation of the new room challenged the prevailing biomedical paradigm within the labour ward context and raised the care providers' awareness about the complex interplay between birth physiology and the environment. This awareness had the potential to encourage care providers to be more emotionally present, rather than to focus on monitoring practices. The new room also evoked a sense of insecurity due to its unfamiliar design, which acted as a barrier to integrating the room as a well-functioning part of everyday care practice. CONCLUSION: Our findings highlight the disparity that existed between what care providers considered valuable for women during childbirth and their own requirements from the built environment based on their professional responsibilities. This identified disparity emphasises the importance of hospital birthing rooms (i) supporting women's emotions and birth physiology and (ii) being standardised to meet care providers' requirements for a functional work environment. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03948815, 14/05/2019.

Effect of Handrail Height and Age on Trunk and Shoulder Kinematics Following Perturbation-Evoked Grasping Reactions During Gait.

OBJECTIVE: To characterize the effect of handrail height and age on trunk and shoulder kinematics, and concomitant handrail forces, on balance recovery reactions during gait. BACKGROUND: Falls are the leading cause of unintentional injury in adults in North America. Handrails can significantly enhance balance recovery and help individuals to avoid falls, provided that their design allows users across the lifespan to reach and grasp the rail after balance loss, and control their trunk by applying hand-contact forces to the rail. However, the effect of handrail height and age on trunk and shoulder kinematics when recovering from perturbations during gait is unknown. METHOD: Fourteen younger and 13 older adults experienced balance loss (sudden platform translations) while walking beside a height-adjustable handrail. Handrail height was varied from 30 to 44 inches (76 to 112 cm). Trunk and shoulder kinematics were measured via 3D motion capture; applied handrail forces were collected from load cells mounted to the rail. RESULTS: As handrail height increased (up to 42 inches/107 cm), peak trunk angular displacement and velocity generally decreased, while shoulder elevation angles during reaching and peak handrail forces did not differ significantly between 36 and 42 inches (91 and 107 cm). Age was associated with reduced peak trunk angular displacements, but did not affect applied handrail forces. CONCLUSION: Higher handrails (up to 42 inches) may be advantageous for trunk control when recovering from destabilizations during gait. APPLICATION: Our results can inform building codes, workplace safety standards, and accessibility standards, for safer handrail design.

Outcomes of a trial of an age-friendly dining initiative: Dining Co.

OBJECTIVES: With the rise of age-friendly cities and communities, increasing attention is being paid to coproducing age-friendly guidelines with older people and community stakeholders. Little is known however about age-friendly guidelines for dining establishments. METHODS: A three-stage study to develop general and contextualised requirements for an age-friendly dining experience was conducted in the City of Onkaparinga, South Australia. The first stage involved older people in co-designing aspects of an age-friendly dining experience. Subsequently, the second and third stage coproduced, trialed and evaluated age-friendly initiatives with two dining venues. RESULTS: Through co-design, seven domains of an age-friendly dining experience were identified (Menu, Affordability, Dementia Awareness, Venue, Feeling Welcome, Special Offerings and Assistance), alongside an overarching desire for a 'meaningful' dining experience. Differences in health and socioeconomic status of diners underpinned the differences needed to ensure an age-friendly dining experience and highlight the importance of contextualisation for the local population. The trial demonstrated positive outcomes for both older diners and venues. DISCUSSION: The environment, value and logistics of dining out are important to older people when making choices about dining in the community. The elements of an age-friendly dining experience presented in this study are a useful starting point for contextualisation to other local settings.

Results from the United Arab Emirates 2022 report card on physical activity for children and adolescents.

Objective: The United Arab Emirates (UAE) 2022 Report Card provides a systematic evaluation of the physical activity (PA) levels of children and adolescents in the UAE. Methods: The 2022 Report Card utilized data from 2017 to 2021 to inform 10 core PA indicators that were common to the Global Matrix 4.0. Results: One in five (19%) UAE school children achieved the recommended amount of moderate-to-vigorous PA (i.e. ≥60 min/d; Total Physical Activity Grade F). Less than 1% of school children used active transport to and from school (Active Transportation Grade F). One in four (26%) secondary school children achieved the recreational screen time recommendations (i.e. ≤2 h/d; Sedentary Behaviours Grade D-). A quarter of adults reported achieving the recommended PA level (i.e. ≥150 min of moderate-intensity PA per week, or equivalent) (Family and Peers Grade D-). All school children are taught physical education (PE) by a specialist with at least a bachelor's degree in PE; however, the duration of weekly PE classes varied between schools (School Grade A-). The UAE Government has invested significant funds and resources into developing and implementing strategies and facilities that will increase PA across the entire population (Government Grade B+). Organised Sport and Physical Activity, Active Play, Physical Fitness, and Community and Environment indicators were graded 'Incomplete' (INC) due to a lack of available data. Conclusions: Overall, PA levels remain low and sedentary behaviours remain high amongst UAE children and adolescents. The UAE Government has sustained investment in further developing PA opportunities for all children and adults which should translate to increased PA and health improvements at a population level.

Applying the sustainable system-of-systems framework: wastewater(s) in a rapidly urbanising South African settlement.

Addressing wastewater infrastructure needs in urban informal settlements must simultaneously address legacies of past failures, current aspirations and constraints, as well as increasingly changing needs related to global environmental change. This study applied the Sustainable System-of-Systems framework for ergonomics and human factors to gain a better understanding of how small in-situ constructed wetlands could be a form of greywater treatment infrastructure in an informal settlement. Using 24 months of interviews, surveys, workshops and photo-ethnographic observations, we identified that the rapidly changing nature of parent (e.g. residency transience and land ownership) and sibling (e.g. housing and drinking water) systems put pressure on the target wetland system to adapt, often decreasing its capacity to deliver the service of water cleaning. Greywater treatment was not a common goal among stakeholders involved in the nested hierarchy system which likely contributed to the constructed wetlands needing to adapt to remain relevant.Practitioner summary: The value of the Sustainable Systems-of-Systems framework for ergonomics/human factors professionals in determining the sustainability of an ergonomics/human factors intervention is demonstrated using a greywater treatment system case study for an urban informal settlement. Understanding the variety of stakeholder goals and the pace of change in related systems was key to a sustainable intervention.

Reclaiming public spaces: The case for the built environment as a restorative tool in neighborhoods with high levels of community violence.

Early-life exposure to neighborhood violence can negatively affect children's socioemotional development and long-term health outcomes. Community-level interventions that modify the built environment to facilitate social encounters can have a positive impact on health. An example of such interventions is the building of green spaces and playgrounds. This case study describes collaboration among residents, local organizations, and a university that aimed to increase the utilization of a vacant lot by converting it into a green space with a playground. Informal conversations at volunteer gatherings and neighborhood association meetings indicated a positive impact of this project in the community. We propose a model for future program implementation and research to improve health in disinvested and disordered communities. We conclude that more research is needed on community partnerships that modify the built environment to decrease community violence. Community-based participatory research may be successful in evaluating future projects with this goal.

Determining the ambient influences and configuration of optimised environments for emotional wellbeing of older adults.

It is now widely recognised that aspects such as tiredness or mood state can have an impact on an individual's wellbeing. However, there also exist other less studied factors that might be influential, and whose analysis is important to maximise personal wellbeing. The aim of this study was to determine the influence of a set of 12 selected factors. Using the analysis of a 20-experiment case study by soft computing techniques the intention was to establish the most appropriate configuration for each factor to compose an optimal living environment to foster wellbeing. The analysis revealed that ambient lighting and stress level are the factors that most impact emotional wellbeing. To a lesser extent, being able to take a break, ambient temperature and ambient noise play a relatively determining role. The findings of this work can be used to establish a living environment for older persons that favours their emotional wellbeing. Practitioner summary: This study analyses the level of influence of a set of ambient factors on the emotional wellbeing of older people, conducting, to this end, a series of controlled experiments, and concluding that ambient lighting and stress level are the factors most relevant to promote a better living environment.KEY POINTSOlder adults' emotional interpretation of pictures depends on the environment and ambient factors.Ambient factors, such as lighting and stress, have a significant, positive effect on visual interpretation of stimuli and greater wellbeing.The use of soft computing techniques facilitates the quantification of the influence of factors affecting emotional wellbeing.

'Nutrition is out of our control': soldiers' perceptions of their local food environment.

OBJECTIVE: To explore the perceptions of soldiers participating in a US Army Office of The Surgeon General's worksite health promotion programme (WHPP) on the local food environment within their campus-style workplace. DESIGN: Focus groups were conducted to evaluate the perceived effectiveness of the WHPP implementation. Further exploration of focus group data through thematic analysis focused on perceived contributions of the military campus-style food environment to soldiers' nutrition behaviours. SETTING: Three US Army installations located in the continental USA. PARTICIPANTS: Active duty soldiers (n 366) participating in one of the fifty-eight focus groups. RESULTS: Soldiers shared a common belief of self-discipline and personal responsibility as the foothold to nutrition behaviour change. Soldiers described aspects of the military campus-style food environment as factors impeding achievement of optimal nutrition. Collectively, soldiers perceived the proximity and density of fast-food restaurants, lack of healthy alternatives on the installation and the cost of healthy food as inhibitors to choosing healthy foods. Overwhelmingly, soldiers also perceived time constraints as a factor contributing to unhealthy food choices. CONCLUSIONS: Although nutrition behaviour is individually driven, soldiers perceived the military campus-style food environment inhibits healthy decision making. Nutrition programming in military WHPP must integrate food environment changes to improve soldiers' nutrition behaviour outcomes. Applicable to the military, food choice behaviour studies suggest environmental changes must be appealing to young adults. Considerations for environmental changes should include an increased portion size for healthy options, broadened use of soldiers' daily food allowances on local produce and increased availability of grab-and-go options.

Reconciling opposing perceptions of access to physical activity in a gentrifying urban neighborhood.

OBJECTIVE: We sought to understand perspectives on access to physical activity in a gentrifying neighborhood. DESIGN: This qualitative descriptive study used street intercept interviews and photo documentation. SAMPLE: Participants included members (n = 19) of a gentrifying neighborhood in a northeastern city. RESULTS: Participants held markedly different perceptions of opportunities for physical activity. Some participants, particularly area university students or those who are identified as White, perceived the neighborhood as favorable to physical activity, with high walkability and abundant resources. Other participants, particularly those who identified as Black or African-American, felt it was difficult to be physically active because neighborhood recreation facilities are scarce or unaffordable and parks are poorly maintained or unsafe. Multiple participants noted strategies to overcome neighborhood barriers to physical activity. Regardless of neighborhood perceptions, family and friends played an important role in influencing physical activity. CONCLUSIONS: Nurses must consider how disparities in actual and perceived access to neighborhood resources influence participation in physical activity, particularly in gentrifying neighborhood. Public health nurses are embedded in the neighborhoods that they serve, providing a unique opportunity to understand and address the impact of neighborhood on health.

Policies in Activity-based Flexible Offices -'I am sloppy with clean-desking. We don't really know the rules.'

Activity-based Flexible Offices (A-FOs) are offices with unassigned desks that provide a variety of workspaces. This paper presents desk-sharing and speech rules identified in A-FOs in four Swedish organisations, the emergence of and compliance with these rules, and their consequences for work conditions. Data collection involved 105 semi-structured interviews, document analyses, and observations. The identified rules were: (1) to remove belongings, (2) temporal restrictions on using the same workstations, (3) temporal restrictions on using scarce zones, (4) restrictions on verbal interactions, and (5) restrictions on phone conversations. The cases with extensive user involvement in their planning process had explicit unambiguous rules. A better compliance with rules occurred when (i) the employees were well-prepared and had a unified understanding regarding how and why to follow the rules, (ii) the rules were explicitly communicated and were regarded as easy to follow, and (iii) following the rules facilitated work and improved work conditions. Practitioner summary: Five rules were identified for applying desk-sharing and speech policies in A-FOs. Extensive user involvement resulted in having well-defined and explicitly communicated rules, and prepared employees for how to use the A-FO. Implicit and ambiguous rules led to conflicting interpretations, disregarding rules, and were associated with more negative work conditions.

Environmental and Socio-demographic Factors Associated with 6-10-Year-Old Children's School Travel in Urban and Non-urban Settings.

Walking or bicycling to school is an important source of physical activity and may help prevent childhood obesity. However, active commuting has been declining in recent decades. The purposes of this study were to explore travel characteristics in children and examine factors associated with active commuting in children living in urban and non-urban setting. Participants were 834 parents and corresponding children aged 6-10 years, living in the district of Coimbra, Portugal. Data were collected during April-June of 2013 and 2014. Anthropometric measures (height, weight, waist circumference) were taken in children. Mode shift and child/family demographics were assessed by a parental questionnaire. School and home addresses were geocoded and the shortest route (meters) was taken in consideration. Although car is the most common way of travel to school, active transportation is significantly more prevalent in children living in the non-urban setting. Different determinants were found associated with active travel according to the level of urbanization. The adjusted logistic regression revealed that, independently of the urbanization, children whose mothers actively commute to work, whose parents reported their neighbor as safe to walk, and children living less than 2000 m from school were significantly more likely to walk to school. Present findings highlight the need to consider models with different levels, including individual, social, and environmental characteristics, when developing interventions and policies to promote active transport to school.

The Relationship Between Objectively Measured Walking and Risk of Pedestrian-Motor Vehicle Collision.

Safe urban walking environments may improve health by encouraging physical activity, but the relationship between an individual's location and walking pattern and the risk of pedestrian-motor vehicle collision is unknown. We examined associations between individuals' walking bouts and walking risk, measured as mean exposure to the risk of pedestrian-vehicle collision. Walking bouts were ascertained through integrated accelerometry and global positioning system data and from individual travel-diary data obtained from adults in the Travel Assessment and Community Study (King County, Washington) in 2008-2009. Walking patterns were superimposed onto maps of the historical probabilities of pedestrian-vehicle collisions for intersections and midblock segments within Seattle, Washington. Mean risk of pedestrian-vehicle collision in specific walking locations was assessed according to walking exposure (duration, distance, and intensity) and participant demographic characteristics in linear mixed models. Participants typically walked in areas with low pedestrian collision risk when walking for recreation, walking at a faster pace, or taking longer-duration walks. Mean daily walking duration and distance were not associated with collision risk. Males walked in areas with higher collision risk compared with females, while vehicle owners, residents of single-family homes, and parents of young children walked in areas with lower collision risk. These findings may suggest that pedestrians moderate collision risk by using lower-risk routes.

Analyzing the impact of public transit usage on obesity.

The objective of this paper is to estimate the impact of county-level public transit usage on obesity prevalence in the United States and assess the potential for public transit usage as an intervention for obesity. This study adopts an instrumental regression approach to implicitly control for potential selection bias due to possible differences in commuting preferences among obese and non-obese populations. United States health data from the 2009 Behavioral Risk Factor Surveillance System and transportation data from the 2009 National Household Travel Survey are aggregated and matched at the county level. County-level public transit accessibility and vehicle ownership rates are chosen as instrumental variables to implicitly control for unobservable commuting preferences. The results of this instrumental regression analysis suggest that a one percent increase in county population usage of public transit is associated with a 0.221 percent decrease in county population obesity prevalence at the α=0.01 statistical significance level, when commuting preferences, amount of non-travel physical activity, education level, health resource, and distribution of income are fixed. Hence, this study provides empirical support for the effectiveness of encouraging public transit usage as an intervention strategy for obesity.

Perceived neighborhood environmental attributes associated with leisure-time and transport physical activity in Mexican adults.

Environmental factors have been associated with specific physical activity domains, including leisure-time and transport physical activity, in some high income countries. Few studies have examined the environmental correlates for domain-specific physical activity in low-and middle-income countries, and results are inconsistent. We aimed to estimate the associations between perceived environment and self-reported leisure-time walking, moderate-to-vigorous leisure-time physical activity and transport physical activity among adults living in Cuernavaca, Mexico. A population-based study of adults 20 to 64years old was conducted in Cuernavaca, Mexico in 2011 (n=677). Leisure and transport physical activity was measured using the International Physical Activity Questionnaire - Long Form. Perceptions of neighborhood environment were obtained by questionnaire. Hurdle regression models estimated the association between environmental perceptions and participation and time spent in each physical activity domain. High perceived aesthetics were positively correlated with participation and time spent in leisure-time walking and moderate-to-vigorous physical activity. SES differences existed for aesthetics in relation to participation in leisure-time walking. Participation in transport physical activity was positively associated with easy access to large parks, while closer distance to large parks was a negative correlate for participation and time-spent in this physical activity domain. Results suggest that perceived environmental characteristics related with physical activity are domain specific. High perceived aesthetics were an important correlate for leisure-time activities among Mexican adults, suggesting that policy strategies aimed at improving this environmental perception may be warranted. Patterns of associations between environmental correlates and transport physical activity differed from those reported in commonly studied high income countries.

The influence of walkability on broader mobility for Canadian middle aged and older adults: An examination of Walk Score™ and the Mobility Over Varied Environments Scale (MOVES).

Neighborhood built environments may play an important role in shaping mobility and subsequent health outcomes. However, little work includes broader mobility considerations such as cognitive ability to be mobile, social connections with community, or transportation choices. We used a population-based sample of Canadian middle aged and older adults (aged 45 and older) from the Canadian Community Health Survey-Healthy Aging (CCHS-HA, 2008-2009) to create a holistic mobility measure: Mobility over Varied Environments Scale (MOVES). Data from CCHS-HA respondents from British Columbia with MOVES were linked with Street Smart Walk Score™ data by postal code (n=2046). Mean MOVES was estimated across sociodemographic and health characteristics. Linear regression, adjusted for relevant covariates, was used to estimate the association between Street Smart Walk Score™ and the MOVES. The mean MOVES was 30.67 (95% confidence interval (CI) 30.36, 30.99), 5th percentile 23.27 (CI 22.16, 24.38) and 95th percentile was 36.93 (CI 35.98, 37.87). MOVES was higher for those who were younger, married, higher socioeconomic status, and had better health. In unadjusted models, for every 10 point increase in Street Smart Walk Score™, MOVES increased 4.84 points (CI 4.52, 5.15). However, results attenuated after adjustment for sociodemographic covariates: each 10 point increase in Street Smart Walk Score™ was associated with a 0.10 (CI 0.00, 0.20) point increase in MOVES. The modest but important link we observed between walkability and mobility highlights the implication of neighborhood design on the health of middle aged and older adults.

Association between socioeconomic and physical/built neighborhoods and disability: A systematic review.

The aim of this systematic review was to assess the association between the characteristics of the socioeconomic and physical/built neighborhoods and disability in basic activities of daily living (ADL) and/or instrumental activities of daily living (IADL). Six databases were searched. Fourteen from the 1811 identified studies were included. Neighborhoods with socioeconomic disadvantage were associated with ADL/IADL disabilities in 7 out of the 11 studies with this objective. Worst features of the physical/built neighborhoods were associated with disabilities in only 3 of the 7 studies that investigated this. Relative to the physical/built, the socioeconomic neighborhood and ADL/IADL disabilities were more consistently associated in the still scarcely available literature on the subject.

Geographic variation in the relationship between body mass index and the built environment.

Studies examining associations between weight status and neighborhood built environment (BE) have shown inconsistent results and have generally focused on urban settings. However, many Americans do not live in metropolitan areas and BE impacts may be different outside of metropolitan areas. We sought to examine whether the relationship between body mass index (BMI) and neighborhood BE exists and varies by geographic region across small towns in the United States. We conducted telephone surveys with 2156 adults and geographic information systems data in nine towns located within three geographic regions (Northeast, Texas, Washington) in 2011 and 2012. Multiple regression models examined the relationship between individual BMI and BE measures. Most physical activity variables were significantly associated with lower BMI in all geographic regions. We saw variation across geographic region in the relationship between characteristics of the BE variables and BMI. Some perceived and objectively-measured characteristics of the BE were significantly associated with adult BMI, but significant relationships varied by geographic region. For example, in the Northeast, perceived attractiveness of the neighborhood as a reason for why they chose to live there was associated with lower BMI; in Texas, the perceived presence of a fast food restaurant was negatively associated with BMI; in Washington, perceived presence of trees along the streets was associated with lower BMI. Our findings suggest that regional variation plays a role in the relationship between adult BMI and BE characteristics in small towns. Regardless of geographic location, interventions should encourage utilitarian walking and other forms of physical activity.

Setting-related influences on physical inactivity of older adults in residential care settings: a review.

BACKGROUND: Despite the detrimental effects of physical inactivity for older adults, especially aged residents of residential care settings may spend much time in inactive behavior. This may be partly due to their poorer physical condition; however, there may also be other, setting-related factors that influence the amount of inactivity. The aim of this review was to review setting-related factors (including the social and physical environment) that may contribute to the amount of older adults' physical inactivity in a wide range of residential care settings (e.g., nursing homes, assisted care facilities). METHODS: Five databases were systematically searched for eligible studies, using the key words 'inactivity', 'care facilities', and 'older adults', including their synonyms and MeSH terms. Additional studies were selected from references used in articles included from the search. Based on specific eligibility criteria, a total of 12 studies were included. Quality of the included studies was assessed using the Mixed Methods Appraisal Tool (MMAT). RESULTS: Based on studies using different methodologies (e.g., interviews and observations), and of different quality (assessed quality range: 25-100%), we report several aspects related to the physical environment and caregivers. Factors of the physical environment that may be related to physical inactivity included, among others, the environment's compatibility with the abilities of a resident, the presence of equipment, the accessibility, security, comfort, and aesthetics of the environment/corridors, and possibly the presence of some specific areas. Caregiver-related factors included staffing levels, the available time, and the amount and type of care being provided. CONCLUSIONS: Inactivity levels in residential care settings may be reduced by improving several features of the physical environment and with the help of caregivers. Intervention studies could be performed in order to gain more insight into causal effects of improving setting-related factors on physical inactivity of aged residents.