AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Associations of Neighborhood Walkability with Six-Minute Walk Distance & Physical Activity in Peripheral Artery Disease (PAD)
By Thangada N, Keegan A, Zhang D et al.
Introduction: Neighborhood walkability refers to the extent to which walking in a neighborhood is safe and accessible. This study assessed whether a higher Environmental Protection Agency (EPA) Walkability Index and whether a greater number of parks in a neighborhood were associated with better baseline 6-minute walk (6MW) distance and physical activity (PA) levels in people with lower extremity peripheral artery disease (PAD). Methods: Baseline data were combined from two randomized clinical trials (GOALS and LITE) of home-based walking exercise for PAD. Participants’ home addresses were geocoded and linked to EPA Walkability Index and National Neighborhood Data Archive for parks at the US Census Block and Tract level, respectively. The primary outcome was 6MW and secondary outcome was PA. PA was measured objectively in both GOALS and LITE. However, only LITE PA data were included in these analyses because the Actigraph accelerometer was used to measure PA in LITE, while the CALTRAC accelerometer was used in GOALS and the two measures are distinct and cannot be combined. Furthermore, Actigraph is more accurate than CALTRAC for measuring PA. Separate multivariable linear regressions evaluated the cross-sectional associations between EPA Walkability Index and number of parks in a neighborhood (independent variables, respectively) with 6MW and PA (dependent variables, respectively). Models were adjusted for age, sex, race, education, smoking, heart failure, myocardial infarction, cancer, ankle-brachial index. Models including PA additionally adjusted for Actigraph wear time. Results: 487 people [mean (SD) age: 69.8 (9.5) years, 48.7% female, 54.8% Black] with available baseline 6MW were included. Baseline mean (SD) 6MW and ActiGraph PA were 336 (95) meters and 109,132 (69,806) counts/day, respectively. EPA Walkability Index was not associated with baseline 6MW but was significantly associated with baseline PA. Every 1-point greater EPA Walkability Index was associated with 2239 counts/day of greater PA (P=0.039). The number of parks in a neighborhood was not associated with baseline 6MW meters or PA ( Figure ). Conclusions: A more walkable neighborhood was associated significantly with higher PA levels, but not with 6MW distance in people with PAD. Longitudinal analyses are needed to determine whether more walkable neighborhoods increase PA in people with PAD.