Non-Vigorous Physical Activity Associated with Reduced Hospitalization Risk with or without Diabetes or Peripheral Artery Disease: Study of Latinos.

The incidence and prevalence of diabetes has risen over the past three decades, placing a substantial burden on healthcare systems [], with associated global health expenditures reaching US$966 billion []. In 2021, an estimated 529 million people of all ages were living with diabetes worldwide, and this number is projected to more than double to 1.31 billion by 2050 []. The global burden of disease (GBD) attributed to diabetes was 37.8 million years of life lost (YLLs) and 41.4 million years lived with disability, yielding a total of 79.2 million disability-adjusted life years (DALYs) []. In the UK, an individual is diagnosed with diabetes every two minutes, and one in 15 people now live with diabetes – approximately 7% of the UK population []. Diabetes is also a significant risk factor for coronary heart disease and stroke [–] which have been identified as the first and third leading causes of mortality in 2021, respectively []. Thus, diabetes is a significant public health challenge. Type 2 diabetes (T2D) is the most common type of diabetes, accounting for 96% of all diabetes cases in adults []. The disease is characterized by low insulin secretion, insulin resistance, and high glycated haemoglobin (HbA) [, ]. Several modifiable lifestyle factors, including physical inactivity, poor diet, and being overweight, play a crucial role in the development and progression of T2D []. The incidence of diabetes can be reduced via lifestyle interventions [] or modifications []. Exposure to residential greenspaces offers a potential avenue for lifestyle interventions by facilitating behaviours such as increased physical activity, greater time outdoors for vitamin D synthesis, reduced sedentary behaviour, and enhanced social interaction, all of which are associated with improved metabolic health [–]. For example, Yuan and colleagues reported that increases in moderate-to-vigorous physical activity and decreases in sedentary behaviours (e.g., leisure screen time) were significantly associated with a reduced risk of T2D, in part due to reduced obesity and chronic inflammation, as well as higher lean mass []. Residential greenspace can also reduce human exposure to environmental air pollutants [] by absorbing particulate matter and nitrogen dioxide (through processes such as deposition) [], which are important risk factors for metabolic dysfunction []. Prospective [–] and retrospective [, ] cohort studies have examined the effects of residential greenspace exposure on the incidence of diabetes, but several research gaps remain. First, existing studies mostly relied on satellite imagery, such as the normalized difference vegetation index (NDVI), to quantify greenspace exposure []. While NDVI tends to homogenize greenspace exposure [], it is limited in capturing the high spatial heterogeneity within urban settings [, ], and does not account for variation in greenspace types [, ], e.g., exposure to private residential gardens and public parks. As an alternative, greenspace typologies derived from land-use datasets (e.g., Ordnance Survey MasterMap™) can be used to capture more functionally distinct greenspace exposures. Second, there is limited evidence on how residential proximity to accessible types of greenspaces (e.g., distance to public parks or community gardens) influences the incidence of T2D. In a systematic review of 13 studies on greenspace exposure and the incidence of T2D, none of the studies measured or operationalized greenspace exposure in terms of proximity or accessibility []. This research gap was also present in a recent prospective cohort study among US women, which lacked information on residential greenspace accessibility or proximity []. Even in broader greenspace proximity-health literature, little is known about the actual health effect of walkable road network distance, with most studies using Euclidean (straight-line) distance as a proximity measures [, ], which may lead to exposure misclassification and biased results []. We have previously shown that exposure to specific greenspace types, such as private residential gardens, varies by socioeconomic status (SES) and may confer greater benefits among less deprived populations, partly due to their greater ability to afford housing with private gardens [, ]. Therefore, providing access to community gardens or public parks to deprived individuals could help address socioeconomic health disparities []. Third, while access to or visit to public parks has been linked with physical and community well-being [, ], evidence on how the density of parks in close proximity to residential homes impacts the risk of being diagnosed with T2D remains limited []. For example, do participants living in areas with ‘one or no parks’ versus those with ‘at least two public parks’ within an 800 m buffer (approximately 10–15 minutes’ walk) from home locations experience the same health benefits, such as a reduced risk of developing T2D? Exploring these questions could help