Access to and availability of exercise facilities in Madrid: An equity perspective

Abstract

Background: Identifying socioeconomic determinants that are associated with access to and availability of exercisefacilities is fundamental to supporting physical activity engagement in urban populations, which in turn, may reducehealth inequities. This study analysed the relationship between area-level socioeconomic status (SES) and access to,and availability of, exercise facilities in Madrid, Spain.Methods: Area-level SES was measured using a composite index based on seven sociodemographic indicators.Exercise facilities were geocoded using Google Maps and classified into four types: public, private, low-cost and sessional.Accessibility was operationalized as the street network distance to the nearest exercise facility from each of the125,427 residential building entrances (i.e. portals) in Madrid. Availability was defined as the count of exercise facilitiesin a 1000 m street network buffer around each portal. We used a multilevel linear regression and a zero inflatedPoisson regression analyses to assess the association between area-level SES and exercise facility accessibility andavailability.Results: Lower SES areas had a lower average distance to the closest facility, especially for public and low-cost facilities.Higher SES areas had higher availability of exercise facilities, especially for private and seasonal facilities.Conclusion: Public and low-cost exercise facilities were more proximate in low SES areas, but the overall number offacilities was lower in these areas compared with higher SES areas. Increasing the number of exercise facilities in lowerSES areas may be an intervention to improve health equity.