Avoiding ‘bungalow legs’: active ageing and the built environment

ABSTRACT

Urban populations across the globe are ageing and much debate has centred on what constitutes an ‘age-friendly’ city. Historic environments, for example, often present physical challenges, such as steps and uneven surfaces – while today these are designed out. Smooth level surfaces, automatic doors and elevators to change level, require little exertion. However, has the fact that in order to keep our bodies healthy into older age, a level of physical exertion in our day to day lives is required, been overlooked? Can activity be designed back into environments without undoing the benefits of accessibility and causing harm to others?

KEYWORDS:

• Age-friendly
• healthy ageing
• inclusive design
• walking
• walkability

Introduction – age–friendly cities and healthy ageing

‘Never move to a bungalow, you’ll get bungalow legs!’ (i.e., lose the inability to climb stairs and generally become less physically fit) - advice from research participant

The shift of global populations to an ageing profile fused with the growth of cities (both size and number) means that for the first time, more people grow to old age in urban settings (WHO 2015). These global trends, underpinned by the long-held recognition that many risks to health arise from the built environment (London 2020); the rise of neo-liberal governments that favour individual responsibilisation for health and well-being that reduces national expenditure (Cavill, Kahlmeier, and Racioppi 2006) and the so-called spirit of the baby boomer generation that brings new aspirational lifestyles and attitudes to ageing and retirement (Phillipson et al. 2008) have focused attention on environments that foster healthy and active ageing. Those settlements that pursue this agenda are termed ‘age friendly’ cities and communities (WHO 2007). However, much debate has surrounded what constitutes an age-friendly city and who its beneficiaries are (Buffel and Phillipson 2018; Van Hoof et al. 2018, 2021). Plouffe and Kalache (2010) assert that recognizing and responding to the diversity of the ageing population is a salient characteristic for a truly age friendly settlement and, in design terms, this means a built environment designed for different capabilities that ‘emphasizes enablement rather than disablement’. In practice however design has taken a pro-disability focus that has worked to eradicate what are judged to be barriers to easy movement – the employment of ramps, rather than stairs, elevators, level non-slip surfaces and so on – these are synonymous with supporting people to access services and facilities and be active in society. Such a design approach merges with the concepts of universal and inclusive design, however it also highlights potential tensions between concepts of places being ‘age-friendly’ and notions of ‘healthy ageing’ for those able to exercise into older age. As the quote at the beginning of this section suggests, today older people may challenge assumptions about what are appropriate and desirable living environments

Handler (2018) takes issue with this pro-disability approach on two grounds. Firstly, this concept of design as a problem-solving technique aligns with a bio medical model of ageing that judges later life as a time of impaired bodies. Secondly, that it has given rise to a standardization of products (seats for example) and solutions that are applied regardless of context or how a location is used or might be used differently by older people. In her playful ‘An alternative age friendly handbook’ (Handler 2014), she encourages designers to think beyond physical needs to address social, cultural and relational dynamics that underpin the everyday life of older people in their environments.

Walking and walkability in older age

Walking is still the main way in which we negotiate the places where we live and spend our recreation time, including as we enter older age. Walking is socially inclusive as it's generally free, as it needs no specialist equipment, however it does require a well-maintained public realm, good lighting, seating and appropriate places to rest and socialize (Townshend 2022). Walking is important for those older persons able to do so, because it enhances cardiovascular health and maintains muscle strength and flexibility – this is important in reducing the risk of falls, which is a specific risk in older age (Smith et al. 2007). It also helps maintain a healthy weight and, when it involves meeting friends and neighbours, can maintain social connectedness – this in turn helps combat feelings of loneliness and isolation which can blight old age. More generally, it can improve mood and mental well-being. ‘People deserve an environment where health-enhancing physical activity is an integral part of everyday life. That can be created only if decision-makers, health professionals and communities take united action and develop effective policies’ (WHO 2014).

Urban design policy and practice has increasingly embraced the concept of ‘walkability’ over the past 20 years. Walkable neighbourhoods, for example, are a key element of New Urbanism and these principles have more recently morphed into the 15-minute neighbourhood¹ (and similar concepts). Walkable environments are those deemed to support those benefits associated with walking – physical activity, mental health and social interaction (Antonio and Herrmann-Lunecke 2021; McCormack et al. 2020). The key physical elements of walkable neighbourhoods, however, have been debated since the concept first emerged, with Ewing and Cervero’s 5 ‘D’s – density, diversity, design, destination accessibility and distance to transit – a commonly cited framework (2010). Nevertheless, Ewing and Handy emphasize that it is the individual’s perception of these characteristics that has greatest influence over their propensity to walk, rather than objective measures (2009). Research on walkability also places much emphasis on the idea of ease of movement – this is especially so when referring to older persons (Ziegler and Schwanen 2011). Conversely, a review of walkability studies specifically focusing on older age groups, found a high level of inconsistency in findings and what might be considered ‘intuitive’ relationships in this age group – for example associations between perceived traffic safety and walking – lacked robust evidence (Van Cauwenberg et al. 2011).

Valuable evidence is also provided by the discovery of ‘blue zones’, defined as areas where people reach age 100 at 10 times greater rates than in the United States (Buettner and Skemp 2016). Though, living longer, is not the only advantage of living in a blue zone. Evidence also suggests older persons in these areas derive many positive physical and psychological health benefits – meaning these areas can tell us much about healthy ageing (Hitchcott, Chiara Fastame, and Pietronilla Penna 2018; Kreouzi, Theodorakis, and Constantinou 2022). One aspect that has been highlighted in research is that benefits are lifestyle driven – as opposed to being genetic. Moreover, while lifestyle factors are multifarious and differ between zones, a key aspect of those lifestyles has been identified as ‘natural movement’ – the idea of living in environments that constantly nudge those residing there into moving instinctively and spontaneously as part of everyday life, including walking up and down slopes, and using stairs – as well as activities such as gardening and doing manual housework (Poulain and Herm 2021).

Nature vs urban debate

There is a vast literature which explores the benefits of walking in nature/greenspace (see for example Kelly et al. 2018). Studies emphasize that nature-based walks improve participants’ moods, sense of optimism, well-being and increase feelings of connection to nature. They have also been shown to mitigate stress and to reduce anxiety and negative rumination (in other words unhealthy fixation on problems). There has been some emphasis within this research that nature-based walking brings with it additional benefits, to walking in urban environments (Jingni, Lin, and Williams 2023). They fit a broader ‘nature is good’ while ‘urban is bad’ narrative. However, the actual number of studies in such reviews is often quite small and the characteristics of ‘urban walks’ are not always particularly clear. One study that examined brain activity in urban and green spaces, for example, suggested that while there was a clear link between levels of brain activity, heightened attention and increased effort required to negotiate busy urban spaces, the patterns of brain activity between walking in quiet urban spaces and greenspaces were remarkably similar (Neale et al. 2020). Factors such as how busy an urban area is and whether is contains ‘natural’ elements, such as street trees, or gardens, therefore, need to be explored in greater detail, especially in relation to active ageing.

Moreover, the potential benefits of walking in historic environments have received little attention. There has, however, been a broader narrative emerging over the past decade from the conservation lobby which focuses on links between historic environments and well-being. Drawing on a broad – though not necessarily robust – range of research (see Townshend 2022, chapter 6), this weaves together themes of engagement, sense of place, place attachment and healing to suggest that historic places not only enrich our lives but may well contribute positively to health and well-being (Daniel, Thomas, and Paul 2014; Monckton and Reilly 2019). It may well be that the ability of historic buildings and places to stimulate our imagination, provide comfort through familiarity and validation of our existence, as well as simply appealing to our aesthetic sense, does provide benefits that walking through a more contemporary urban scene would not.

Challenging historic environments and learning from global practice

Whether historic environments provide the benefits outlined above does remain to be proven, what is beyond doubt, however, is that historic areas in cities tend to be more challenging to walk around than those built in the recent past. Uneven surfaces – such as traditional cobbles – stairs, steep slopes and suchlike are certainly challenging for those with mobility and other impairments, Figure 1. However, the extra exertion, maintenance of balance and so on required, could also aid healthy ageing. Climbing stairs uses 8–10 times the energy required for the resting state and regularly using stairs has been shown to maintain healthy body weight, lower blood pressure and increase aerobic fitness entering older age (Whittaker et al. 2021) and overall can limit age-induced physiological decline (Donath et al. 2014). The benefits of negotiating challenges such as stairs in outdoor spaces, however, have received little attention. A scoping review of walkability papers, for example, found only 2.4% of primary research included the presence or absence of stairs in their measures, and these generally regarded stairs as simply a barrier to walking, in other words, without challenging this preconception (Edwards and Dulai 2018). This concluded that while stairs could be beneficial as part of an environment that posed enough challenge to maximize physical activity benefits of users – but not so much of a challenge that is incurred negative outcomes – not enough was known about the design and nature of external stairs to draw definitive conclusions.

Figure 1. Uneven surfaces, slopes, and steps in an historic environment – San Gimignano, Italy.

Source: Photo by the authors.

Uneven surfaces are also sometimes included in walkability indices – though again largely as a necessarily negative factor. However, walking on uneven surfaces is known to promote the coactivation of more muscles than flat surfaces, and promotes hip and knee function (Voloshina et al. 2013). An 8-week intervention study that recreated the experience of walking on cobblestones – as compared to a flat surface – for older adults delivered improved outcomes for participants in terms of reduced blood pressure, increased general fitness levels, and better balance (Li, Fisher, and Harmer 2005). The work was inspired by reflexology paving in public parks in China and elsewhere in southeast Asia, which many older people walk on in the (seeming correct) belief that it will improve their general health (see Figure 1). While there was some initial discomfort among the cobble walking group, many of those who took part wished to continue after the study. Moreover, though the purpose built reflexology ‘mats’ of cobble stones in parks are more extremely uneven than might be generally found in pedestrian environments, the underlying health mechanics apply for all surfaces that are only slightly uneven – such as a traditional cobbled street (Voloshina et al. 2013) (Figure 2).

Figure 2. Reflexology paving in a public park in Beijing.

Source: Photo by the authors.

More generally China provides many interesting examples of active ageing in public – most generally in public parks and residential neighbourhoods (Figure 3), though activities overflow into a variety of locations – even occurring in places such as pedestrian subways, and underneath elevated roads. The key issue to these activities is not so much physical provision – though this is clearly utilized – but more a cultural one. Research with older Chinese people reveals a strong reliance on traditional health `recipes` that includes walking and exercise (Cerin et al. 2013). Another study reveals the importance of designing culturally appropriate environments to facilitate older Chinese American immigrants to maintain their preference for walking (Liu et al. 2021). Medical treatment in China is relatively expensive and older persons spend much effort in maintaining their health as a consequence. While of course no-one would promote a fear of accessing health services as a way of encouraging active ageing in public, with global healthcare systems in crisis and economic growth depressed not least by falling healthy life expectancy and unhealthy populations, there is an imperative to consider the pro health benefits of all our environments.

Figure 3. Older persons in China will often exercise in public parks.

Source: Photo by the authors.

Discussion and conclusion

It's over two decades since the concept of universal design became widely accepted by built environment disciplines and a key aspiration in the field of urban design. The achievements brought forward by this change in approach have been transformative. The ambition to create towns and cities that are physically inclusive and accessible to all, is socially just and equitable. However, might the consequences of removing every physical challenge to our movement around the places we live, have unforeseen consequences? Might we all be in danger of developing those ‘bungalow legs’ so dreaded by our research participant? This paper suggests that it is at least time to revisit this issue in the light of discussions around how populations not just age, but age healthily. There is then an opportunity to open up a dialogue about how we move forward – can you, for example, create universality in the quality of experience – so that everyone feels dignified, catered for and welcome in public spaces, while at the same time addressing plurality of needs, wants and aspirations and thereby not necessarily advocating exactly the same experience for all?

There is also a danger in assuming built environment disciplines know everything there is to know about what older people desire in a public space. However, as Handler (2014) has pointed out, this is not necessarily the case. Moreover, designing for disability as a way of catering for older persons is incredibly patronizing. The age at which people even consider themselves ‘old’ has changed dramatically in recent years and yet, in many ways, general societal attitudes about what is ‘appropriate’ for older persons has not. As urban designers, perhaps we can start with challenging what we really know about walkability and walking in older age. Where the generally accepted 400 m (sometimes 500 m) rule came from as a desirable walking distance to local shops and services, for all is, for example disputed (see Townshend 2022, chapter 3). Indeed, people’s propensity to walk will vary hugely dependent on culture, climate and so on, as well as the individual’s age and ability. In essence, we need far more sophisticated and nuanced understanding of older person's walking and other active engagement in public space.

The notion of accommodating plurality, while creating universality in experience sounds impossibly complex, but is it in reality? Most books of country walks offer route choices graded from easy through moderate, to challenging. The greater exertion may refer to length and time needed to complete the walk, but also the obstacles encountered such as stiles, stepping stones or the degree of steepness and altitude to be negotiated. This care and attention helps to facilitate a walking experience for a range of abilities as well as those walking in groups, or families, with a variety of age ranges and abilities. Accommodating younger walkers in urban areas has also been experimented with, for example Kidlington in Oxfordshire (UK) uses animal paw prints to designate a range of ‘zoo trails’ with different points of interest and activity intended to get children walking, scooting and cycling (Rowe 2024). Drawing on these examples it would be possible to design similar approaches to accommodate older walkers in historic environments, by designating routes that offer easy non demanding walking, through to those that include steep streets, steps and/or cobbled streets. Thereby allowing users a choice. Route ways would need to be supported by resting places that offer opportunities to take a breath and/or to reflect on a fine building or piece of public art (Gilroy 2021, chapter 2). Routes and points of interest could be displayed on interpretation boards, colour coded signage, as well as on way finding digital platforms. The need for a bit of support that might include handrails – which might usefully be multi-level rather than the ‘one height fits all’ variety – on steps can be provided through design that pays attention to context and does not detract from the quality of that place.

As a discipline we also need to develop a much more erudite understanding of the role of urban greenspace in relation to healthy ageing and to reconsider the binary argument that nature and green space are good for us, and that urban environments are bad when it comes to walking and exercise. Growing awareness of the need for sustainable cities; the imperative to reduce air pollution and carbon emissions; the need to reduce traffic stress and take environmentally responsible decisions has led to an increase in walking and cycling and investment by city place makers in developing active travel routes and areas of planting. These changes are welcome in making our cities more attractive and may indeed encourage people of all ages to get out of their homes and participate. However, to take a holistic pro health approach, urban settlements need to exploit all their environments and the causal pathways to healthy ageing are currently poorly understood.

The ways in which people think about ageing from ordinary individuals to expert gerontologists have changed in the recent past and are still evolving. Discovery of those places defined as blue zones – which in essence may be considered as natural experiments in healthy ageing – for example, challenge widely held preconceptions about what it means to age healthily and how we go about achieving this goal. They have also stressed that living in places that encourage us to be active are a key element in positive ageing processes. Urban designers have strived for inclusion over the past two decades, which has been a highly laudable aspiration. However, has inclusion, included the changing understandings of a healthy old age? We would argue that not only has this not happened, but actually these two spheres of understanding are now pulling in very different directions; and we need to find common ground. Ingrid Bergman once said that getting old was ‘like climbing a mountain; you get a little out of breath, but the view is much better’, maybe if the places we live encourage us to get a little out of breath in our daily lives, it’s no bad thing.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. A neighbourhood that allows people to access most of their daily needs within a 15-minute walk or cycle ride from their home.