目的：老年健康问题逐渐受到各国政府关注,改善健身环境被视为改善健康的一项战略方案。然而,尚未清楚健身环境诸因素中哪些因素影响老年人健康状况,及体力活动在其中所产生的作用。本研究主要探究健身环境诸因素对老年人健康的影响机制,以期改善健身环境特征,促进老年人健康状况。方法：随机抽取南京市32个社区499名老年人,采用问卷调查基本信息,三维加速度计和GPS测量老年人户外活动强度、时间和活动轨迹,利用GIS提取客观健身环境因素,使用AMOS 22.0对结构方程模型进行检验。结果：人口密度和街道连通性对老年人健康产生直接影响,效应量分别为0.100、0.121；人口密度、交通站点数和至商业场所距离通过体力活动对老年人健康产生间接影响,效应量分别为0.041、0.067、0.086。研究还发现体力活动在建筑密度、人均道路总长度、交通站点数、至健身场所距离、至商业场所距离与女性老年人健康状况间起到中介作用,对男性无中介作用。结论：健身环境诸因素中人口密度、街道连通性、交通站点数和至商业场所距离对老年人健康产生正向促进作用；与轻体力活动相比,中高体力活动在健身环境与健康之间起到的中介作用较大。健身环境诸因素对老年人健康的影响程度大小排序人口密度＞街道连通性＞至商业场所距离＞交通站点数；健身环境诸因素对老年人健康的影响也在性别差异。

Objective: The health problem of the elderly has gradually attracted the attention of governments all over the world. Improving the built environment is regarded as a strategic plan to improve health. However, it is not clear which of the factors of community built environment affect the health status of the elderly and the role of physical activity. This study mainly explores the impact mechanism of various factors of community built environment on the health of the elderly, in order to improve the characteristics of community environment and promote the health status of the elderly. Methods: 499 elderly people from 32 communities in Nanjing were randomly selected. The basic information of questionnaire survey, three-dimensional accelerometer and GPS were used to measure the outdoor activity intensity, time and activity trajectory of the elderly. The objective environmental factors were extracted by GIS, and the structural equation model was tested by AMOS 22.0. Results: population density and street connectivity had a direct impact on the health of the elderly, and the effect amounts were 0.100 and 0.121 respectively; Population density, the number of traffic stations and the distance to commercial places have an indirect impact on the health of the elderly through physical activity, and the effect amounts are 0.041, 0.067 and 0.086 respectively. The study also found that physical activity plays an intermediary role between building density, total length of roads per capita, number of traffic stations, distance to fitness venues, distance to commercial venues and health status of female elderly, but not men. Conclusion: among the factors of community built environment, population density, street connectivity, number of traffic stations and distance to commercial places have a positive effect on the health of the elderly; Compared with light physical activity, medium and high physical activity plays a greater intermediary role between built environment and health. The influence degree of community built environment factors on the health of the elderly is in the order of population density > street connectivity > distance to commercial places > number of traffic stations; The influence of various factors of community built environment on the health of the elderly is also different in gender.

国家社科基金一般项目(18BTY098);“江苏社科英才”计划项目资助。