Search Results (767)

Although considerable research has investigated non-motorized treadmills (NMTs), most studies have focused on healthy adults or athletes. This study aimed to compare trunk and lower limb muscle activation during walking on an NMT and flat ground (FG) at different exercise intensities in patients with stroke. Eighteen patients with stroke participated in this within-subject, repeated-measures experimental study conducted at a single hospital. Participants performed walking trials under six randomized conditions, comprising both NMT and FG walking at intensities of 20%, 40%, and 60% of heart rate reserve (HRR). Muscle activation of the affected-side erector spinae, internal oblique, gluteus medius, gluteus maximus, vastus medialis oblique, biceps femoris, and lateral gastrocnemius was assessed. Walking on the NMT resulted in significantly greater overall muscle activation than walking on FG (p < 0.05). In addition, significant differences in trunk and lower limb muscle activation were observed across HRR levels during both NMT and FG walking (p < 0.05), indicating that exercise intensity influenced neuromuscular responses. These findings suggest that NMT walking, particularly at higher intensities, acutely increases neuromuscular demands, providing preliminary evidence for its potential application as a demanding walking condition for stroke rehabilitation. Full article

Background: Fibromyalgia is a chronic condition characterised by widespread pain, fatigue, sleep disturbances, and psychological symptoms. Mindfulness-based approaches are increasingly used as complementary interventions for symptom management. This study aimed to investigate the effectiveness of mindfulness-based yoga (MBY) delivered via telerehabilitation in individuals with fibromyalgia. Methods: This trial included 64 women with fibromyalgia who were randomly assigned to an 8-week mindfulness-based yoga program delivered via telerehabilitation or active control group including walking and physiotherapy modalities. Both groups received patient education at the outset. Assessments were conducted before and after the intervention. Outcome measures included fatigue, anxiety, depression, sleep quality, symptoms associated with central sensitization, kinesiophobia, pain intensity, mindfulness level, impact of fibromyalgia on life, biopsychosocial status, and pain catastrophising. Data were analyzed using mixed-design analysis of variance (ANOVA), with additional t-tests and analysis of covariance (ANCOVA) conducted for post hoc analyses. Results: Compared to the control group, the mindfulness-based yoga (MBY) group showed more pronounced improvements in terms of fatigue, anxiety, symptoms associated with central sensitization, biopsychosocial status, symptom severity, catastrophising about pain, ruminative thoughts about pain, and cognitive dimensions of pain. Although no significant differences were found between groups for other variables, intra-group improvements were observed in the MBY group. Conclusions: It was concluded that the MBY intervention administered via telerehabilitation is a viable complementary approach to traditional treatments in reducing the symptom burden of fibromyalgia. It was thought that the effectiveness of the research could be increased by conducting studies involving long-term follow-up assessments and investigating the integration of different mindfulness-based telerehabilitation interventions into the clinical setting. Full article

Background/Objectives: Foot and ankle presentations during Hajj occur in a dense mass-gathering environment where prolonged walking, heat exposure, crowding, variable footwear, and limited self-care can interact with chronic disease and wound vulnerability. Previous Hajj studies have described foot injuries and diabetes-related complications, but less is known about whether simple high-risk foot documentation flags identify presentation records with higher care-pathway intensity. The primary objective was to estimate the presentation-level burden of core high-risk foot profiles among pilgrims presenting with foot and ankle conditions during Hajj 2025. Secondary objectives were to evaluate associations with a surgery-coded care-intensity indicator, hospital referral, and component heterogeneity. Methods: This observational presentation-level analysis included 3957 foot and ankle presentation records. The unit of analysis was the presentation/case record, not a unique individual pilgrim. A core high-risk foot profile was defined as diabetes, neuropathy, diabetic foot ulcer, foot ulcer, complications of open wound, or osteomyelitis. The primary outcome was a surgery-coded care-intensity indicator, defined solely from treatment documentation containing “Surgery” and interpreted as a care-pathway proxy rather than confirmed operating-room surgery. Logistic regression estimated crude and adjusted odds ratios (ORs); exploratory risk-category analyses assessed heterogeneity within the composite profile. Results: Core high-risk foot profiles were identified in 1793/3957 presentations (45.3%). The primary outcome occurred in 239/1793 high-risk presentations (13.3%) and 201/2164 non-high-risk presentations (9.3%), an absolute difference of 4.0 percentage points. The crude OR was 1.50 (95% CI 1.23–1.83; p < 0.001). The association persisted in the primary adjusted model (adjusted OR 1.47; 95% CI 1.20–1.79; p < 0.001) and in the extended clinical sensitivity model (adjusted OR 1.47; 95% CI 1.20–1.80; p < 0.001). Care pathways and secondary outcomes are summarized was also more frequent in high-risk presentations (12.2% vs. 9.8%; crude OR 1.28; 95% CI 1.05–1.57; p = 0.017). Exploratory category analysis showed that chronic-risk-only presentations had a primary outcome rate similar to non-high-risk presentations (9.0% vs. 9.3%), whereas ulcer/wound/deep-infection presentations had a higher rate (17.3%; crude OR 2.04; 95% CI 1.63–2.55; p < 0.001). Model discrimination was modest (C-statistics 0.55–0.64). Conclusions: Core high-risk foot flags were common among Hajj foot and ankle presentation records and were associated with surgery-coded care-intensity and referral documentation. However, the composite was clinically heterogeneous, the outcome was not a validated surgery endpoint, and the models were not prediction tools. These findings support cautious use of high-risk foot flags as operational prompts for assessment and pathway planning rather than as standalone clinical risk estimates. Full article

This study aims to empirically analyze the patterns, intensity, and perceived barriers to physical activity among Polish university students during the COVID-19 pandemic. The research utilized a diagnostic survey method, employing a questionnaire. The online survey was conducted from December 2020 to May 2022 via the Webankieta.pl platform. The minimum sample size, calculated using the standard formula for estimating a proportion in a large population, was set at 1100 participants and was exceeded, with 1260 students providing valid responses. The results show that over half (55.8%, mainly women) of the respondents did not participate in regular physical activity during the pandemic. Participants cited lack of desire, fatigue, and low motivation—not pandemic restrictions—as primary reasons. Conversely, 44.2% of respondents, mostly men, reported engaging in regular physical activity. Most engaged in moderate-intensity activities two to five times a week, with vigorous activities performed slightly less often. Women were more likely to do both types, while men favored strength training. The most common activities included walking (61.6%), simple gymnastic exercises (43.1%), strength training with equipment (35.0%), cycling (34.5%), and calisthenics (30.2%). The majority (81.3%) exercised at home or nearby (33.4%). Reported barriers, especially among those who exercised regularly, were pandemic-related, such as limited or closed access to gyms, fitness centers, and pools (59.1%), along with time constraints (44.7%) and low motivation or determination (32.0%). The findings emphasize the importance of targeted interventions to boost physical activity among university students, particularly women and those with fewer financial resources. Universities should consider implementing programs that promote accessible, regular activity and initiatives to enhance motivation and foster long-term, health-promoting habits. Full article

This study investigates the feasibility, accuracy, and data-sufficiency requirements of smartphone- and smartwatch-based crowdsensing for pedestrian bridge modal identification under real-world conditions. Full-scale experiments were conducted on a bridge across two crowdsensing scenarios with varying dynamic excitation intensities by six pedestrians performing walking, running, and bicycling activities while carrying smartphones and wearing smartwatches. Triaxial acceleration data were collected over 300 s and processed using a framework comprising preprocessing, modal estimation, growing-window convergence analysis, and block-bootstrap uncertainty quantification. Using the full dataset, both devices reliably identified the four consistently detectable bridge modes with average errors of approximately 3% across the scenarios relative to the benchmark. In the convergence analysis, smartwatches consistently produced narrower confidence intervals and more stable early-window estimates, which may be related to their more constrained wearing condition and reduced incidental motion compared to pocket-carried smartphones. Higher pedestrian excitation with additional pedestrians running accelerated the convergence, reducing the required data duration and number of pedestrian passes, albeit with increased uncertainty. The study established data-sufficiency thresholds, showing that reliable modal estimates require in the range of 5–17 walking or running passes, while bicycling passes range from 14 to 28, depending on bridge excitation level and device type. Results demonstrate that commodity smartphones and smartwatches are viable, scalable, and cost-effective platforms for crowdsensed bridge modal identification, provided that uncertainty ranges are properly accounted for and sufficient passes across different pedestrian activities are collected to achieve the desired accuracy. Full article

In the context of subtropical cities, the slow-moving environment of HOD (Hospital-Oriented Development) faces the dual challenges of spatial fragmentation and an extreme hot and humid climate, which also restricts the outdoor space’s thermal environment performance. Taking the Macau Light Rapid Transit (LRT) Union Hospital Station as an example, this study constructs a “topology-climate” dual quantitative assessment framework that integrates space syntax and parametric universal thermal climate index (UTCI) simulation. In response to the current problems of mixed pedestrian and vehicular traffic and high-intensity heat radiation, a comprehensive intervention strategy combining three-dimensional stitching and spatial optimization is proposed. The results show that: (1) The implantation of three-dimensional corridors improved the spatial integration of the core area of the site by 67.0%, significantly optimizing network connectivity. (2) During the extreme high-temperature period of daytime (9:00–18:00) in summer and autumn, the intervention strategy precisely opened up a continuous low-heat-stress linear shade zone through the synergistic mechanism of building projection shadows, physical shading of connecting corridors, (landscape shading effect, original evaporation removed). (3) The study confirms that landscape-coupled shading layout is the most effective method, reducing potential pedestrian heat exposure across the entire area, while the three-dimensional connecting corridors precisely control the thermal environment of core walkways. Together, these two elements construct a “topology-climate” optimization framework, achieving a synergistic improvement in spatial accessibility and simulated thermal comfort performance under standard meteorological input and quantitatively verifying the optimization effectiveness of the tiered intervention scheme. This study provides a data-driven decision-making basis for optimizing potential walking thermal conditions for vulnerable groups and reshaping the space’s potential to improve microclimate via shading design of medical hub areas and also provides a scientific paradigm for TOD microclimate planning focused on shading-based thermal environment optimization. Full article

Background: Migraine (MIG) management guidelines support a comprehensive approach combining medication, therapeutic patient education (TPE), behavioral strategies, lifestyle changes, diet, and physical activity (PA). Objective: To present an innovative interdisciplinary outpatient model for individuals with MIG, focusing on PA, sedentary behavior, eating habits (EH), metabolic health, temporomandibular disorders, and postural dysfunctions. Design: A randomized controlled trial will enroll 200 adults with MIG over two years. Inclusion criteria are chronic MIG (≥15 attacks/month for ≥3 months) or high-frequency episodic MIG (8–14 attacks/month), physical inactivity, and independent walking ability. Exclusion criteria include contraindications to PA and lack of informed consent. Participants will be randomized to standard care (SC) or an intervention group receiving TPE plus three months of supervised exercise (EXE). All participants will receive an informational brochure with nutritional tips (included in SC) and undergo: (1) neurological examination, (2) validated questionnaires, (3) kinesiological and postural assessment, and (4) gnathological evaluation. The primary outcome is change in monthly MIG frequency at 6 and 12 months; additional outcomes include disability, quality of life, and intensity of MIG, PA levels, sedentary behavior, medication use, EH, functional capabilities, postural parameters, and temporomandibular disorder-related variables. Results: Hypothetically, the intervention may reduce monthly MIG frequency by approximately 15–20% relative to baseline. Improvements may also occur in disability, quality of life, medication use, lifestyle behaviors, and psychological and cardiometabolic parameters. Conclusions: This trial will evaluate whether adding supervised EXE and TPE to SC may improve MIG outcomes compared with SC alone, supporting a comprehensive management strategy. Full article

Background: High-intensity interval training (HIIT) is increasingly used in exercise-based cardiac rehabilitation (ebCR) after myocardial infarction (MI), yet the temporal sequence of physiological, cardiac, biochemical, and functional adaptations remains incompletely characterized. Methods: Stable post-STEMI (ST-segment elevation myocardial infarction, MI-group) and previously inactive participants without known cardiovascular, metabolic or systemic disease (CTRL group) completed 12-week supervised outpatient HIIT (4 × 4 min intervals at 85–90% HRpeak (peak heart rate), ~80–90% of VO₂peak, 3 sessions/week). Assessments were performed at baseline (T1), 4 (T2), 8 (T3), and 12 weeks (T4), including cardiopulmonary exercise testing (CPET), echocardiography, blood biomarkers, body composition, six-minute walk test (6MWT), and RAND-36. Longitudinal changes were analyzed using Friedman tests with Dunn post hoc comparisons; between-group differences used Mann–Whitney U tests with Holm correction. Results: VO₂peak increased significantly in both groups (p < 0.001), increasing by ~22% from T1 to T4 in MI (median 20.1 to 24.5 mL·kg⁻¹·min⁻¹) and ~23% from T1 to T4 in CTRL (median 22.3 to 27.6 mL·kg⁻¹·min⁻¹). LVEF (left ventricular ejection fraction) improved early in MI, increasing from 52.5% (50.0–55.0) at T1 to 57.5% (55.2–58.7) at T2 and up to 60% (55.8–60.0) at T4 (all p < 0.001), while LV dimensions remained stable. NT-proBNP (N-terminal pro-B-type natriuretic peptide) showed no significant longitudinal change (p = 0.510), and CRP (C-reactive protein) decreased from 2.1 to 0.7 mg·L⁻¹ (p = 0.008) in MI. Both groups improved body fat % and 6MWT distance (p < 0.001). Conclusions: In low-risk stable post-STEMI patients, longitudinal changes during supervised HIIT-based ebCR were consistent with improved VO₂peak and LVEF, without clinically relevant increases in cardiac stress biomarkers. However, due to the observational design and absence of clinical comparator groups, these findings should be interpreted as descriptive and support further evaluation in larger randomized studies. Full article

Seasonal variability in feed availability in Mediterranean dairy sheep systems can compromise animal performance and welfare, highlighting the need for reliable, high-frequency monitoring tools. Live weight (LW) is a key indicator of nutritional status, but conventional measurements are labour-intensive and poorly suited to dynamic conditions. Walk-over-weighing (WoW) systems integrated with electronic identification (EID) enable automated, continuous, individual-level LW monitoring. This study assessed the sensitivity of a WoW system to detect nutritionally driven LW changes in Sarda dairy ewes under indoor and grazing conditions. Two experiments were conducted: an indoor short-term nutritional challenge involving 24 non-lactating ewes and a grazing trial with contrasting pasture access times involving 48 lactating ewes. In both experiments, the WoW system detected consistent LW differences between nutritional treatments (p < 0.001), capturing both short-term responses and sustained LW dynamics. Differences were approximately 5%, indicating that the WoW system was sensitive to nutritionally induced LW variation under the experimental conditions of the present study, before marked changes in body condition score (BCS) became detectable. These results demonstrate that WoW systems can reliably capture LW trajectories in response to nutritional variation. However, LW responses should be interpreted cautiously, as short-term variation may also reflect gut fill and hydration dynamics, and intake information was not fully available at the individual level because some feed intake components were measured at the group level or estimated indirectly. Integrating automated LW data with production and management information may support group-level nutritional decisions and early detection of animals deviating from expected LW trajectories in precision dairy sheep systems. Full article

In China, policy-driven rural renewal projects have transformed many village public spaces, but some renewed sites are still weakly integrated into villagers’ everyday routines. This study asks why some renewed public spaces sustain routine use and low-intensity social interaction, while others remain materially complete but socially weak. The study was conducted in a rural township in Puyang County, Henan Province. Twelve renewed public spaces across several villages were examined through structured spatial audits and 579 resident questionnaires. Five spatial conditions were assessed: visibility, stay support, activity accommodation, interaction-supportive arrangement, and experienced locational convenience. Two behavioral outcomes were used to describe post-renewal vitality: use frequency and social participation. The analysis combines necessary condition analysis (NCA) and fuzzy-set qualitative comparative analysis (fsQCA). NCA is used as a diagnostic tool for identifying upper-limit constraints, while fsQCA is used to identify sufficient combinations of conditions. The results suggest that experienced locational convenience is the clearest bottleneck condition for both outcomes. When a site is difficult to incorporate into residents’ daily walking routines, internal design quality has limited capacity to translate into sustained behavioral use. Among better-located spaces, high vitality is associated with several design configurations. The most stable recurrent pattern combines visibility, stay support, and locational convenience as core conditions, together with either interaction-supportive arrangement or activity accommodation. Low-vitality spaces follow a different logic, being characterized by the simultaneous absence of several supporting conditions rather than by the absence of one isolated feature. The paper therefore proposes a two-step diagnostic logic for rural public-space renewal: first checking whether a site is embedded in everyday mobility and then matching internal spatial conditions with local patterns of use. Full article

Objective: Long COVID (LC) has been defined as a chronic condition that occurs after SARS-CoV-2 infection and persists for more than 3 months. Dyspnea is the most common and disabling symptom with several mechanisms identified. The pathophysiology of post-COVID dyspnea is unknown. The aim of this study is to analyze the clinical profile of patients presenting with dyspnea in the context of LC and to assess its possible relation with complementary diagnostic tests. Material and Methods: This is a retrospective cohort study including adult patients diagnosed with LC attending a post-COVID outpatient clinic. Dyspnea was assessed using mMRC and Borg scales. Complementary tests included chest imaging, pulmonary function tests (PFTs) and a six-minute walk test (6MWT). These assessments were performed at several time points throughout follow-up (3, 6, and 12 months). Results: Eighty patients diagnosed with LC were included, the mean age was 60.0 ± 14.4 and 43 (54.8%) were female. Most patients were hospitalized during acute infection (97.5%) and 25 patients experienced respiratory failure. During the follow-up, chest X-rays showed persistent abnormalities in 67.5% of patients, and 6MWT was pathological in 61.3% at 277 days (IQR 176–326) after acute infection. No significant differences were observed in the prevalence of ventilatory failure across dyspnea severity categories. Reduced DLCO was observed in 20% of patients, while obstructive or restrictive patterns were infrequent. Through three follow-up visits, pulmonary function and exercise capacity remained stable, with modest improvements in DLCO and exercise-induced desaturation (p = 0.005). In multivariable analysis, obesity (adjusted OR 7.88; p = 0.023) and lower DLCO (p = 0.049) were independent predictors of more severe dyspnea, highlighting the role of non-pulmonary factors in Long COVID. Conclusions: This study describes the clinical and functional profile of a cohort of patients with LC. Although abnormal findings were frequent, only impaired DLCO and obesity were independently associated with dyspnea severity, while imaging and six-minute walk test abnormalities showed no consistent association with symptom intensity, supporting a multifactorial origin of post-COVID dyspnea. Full article

Cutaneous Larva Migrans (CLM) is a neglected tropical disease (NTD) caused by zoonotic Ancylostomatidae larvae, mainly Ancylostoma braziliense and Ancylostoma caninum, which infect dogs and cats. Humans are accidental hosts, acquiring infection when L3 larvae in contaminated soil penetrate the skin, producing serpiginous, pruritic lesions. We report a 24-year-old female from Quito, Ecuador, who developed a pruritic lesion on her right foot nine days after walking barefoot on wet, potentially fecally contaminated sand at Atacames Beach. Initial self-treatment with benzyl benzoate and herbal washes, followed by misdiagnoses as scabies and plantar warts, delayed proper care. Lesions progressed over three weeks with intense pruritus and functional impairment. CLM was correctly diagnosed by a podiatric technician 26 days post-exposure. Oral albendazole (400 mg/day for 4 days) led to rapid symptomatic relief within three days, with complete resolution by day 50. A survey analyzed by the McNemar Test revealed difficulties in recognizing early-stage CLM, regardless of experience or region among participants. Prevention requires personal protection, environmental sanitation, and regular anthelmintic treatment of dogs and cats. This case underscores the clinical consequences of delayed or incorrect diagnosis and highlights the need for enhanced healthcare training and One Health measures to reduce zoonotic diseases in Ecuador. Full article

Background: The factors contributing to physical inactivity in patients with asthma remain unclear. We aimed to explore the pulmonary and extra-pulmonary factors associated with physical activity (PA) in these patients, with stratification by activity intensity. Methods: Patient demographics, Charlson Comorbidity Index, lung function, bronchial and alveolar nitric oxide (NO) levels, six-minute walk test (6 MWT), and PA were cross-sectionally evaluated in healthy participants (n = 14) and patients with asthma (n = 29). The desaturation–distance ratio (DDR) was measured as an index derived from travel distance and desaturation levels during the 6 MWT. Results: Patients with asthma had significantly lower PA than healthy participants, regardless of activity intensity (≥2 metabolic equivalents [METs]: 198 min vs. 240 min, p < 0.05; ≥3 METs: 54 min vs. 86 min, p < 0.05; ≥4 METs: 10 min vs. 26 min, p < 0.01). Extra-pulmonary factors (age, comorbidities, and 6 MW distance) showed higher correlation coefficients with PA as activity intensity increased. Contrastingly, pulmonary factors (asthma severity, airflow limitation, and alveolar exhaled NO) showed lower correlation coefficients with PA as activity intensity increased. The DDR was negatively associated with active time across all activity intensities. Conclusions: Our findings suggest that aging and comorbidities are potential limiting factors for moderate-to-vigorous physical activity, whereas asthma severity and airway dysfunction restrict daily life in patients with asthma. Moreover, the DDR could facilitate detection of real-life physical inactivity in patients with asthma. Full article

Background/Objectives: To evaluate the associations and concurrent validity between baseline functional and morphofunctional assessments in patients with cardiovascular disease participating in a Phase II cardiac rehabilitation program, as a basis for informing individualized exercise prescription. Methods: We conducted an observational retrospective cross-sectional study of patients enrolled in a Phase II outpatient cardiac rehabilitation program (January 2021–December 2023, Málaga). Functional assessments included handgrip strength (HGS), isometric biceps and quadriceps dynamometry, and direct assessment of 20-repetition maximum (20RM) through dynamic resistance exercises using external loads (defined as the maximum load allowing approximately 20 repetitions to near muscular fatigue). Aerobic capacity was evaluated using the 6-min walk test (6 MWT) and a modified Bruce exercise stress test with estimated METs. Morphofunctional assessment included vector bioimpedance analysis (phase angle [PhA], fat-free mass [FFM], body cell mass [BCM]) and rectus femoris ultrasound (cross-sectional area [RF-CSA] and contracted diameter [RF-CON]). Correlation and linear regression analyses were performed. Results: The sample included 223 participants (78.0% male; age 57.7 ± 8.6 years). HGSmax correlated strongly with 20RM biceps (r = 0.89) and moderately with quadriceps (r = 0.72). 6 MWT distance and speed correlated with ergometry-derived METs (r = 0.38–0.40; p < 0.001), whereas Borg ratings correlated inversely with METs and exercise time (r = −0.32 to −0.34; p < 0.001). PhA, BCM, FFM, and rectus femoris ultrasound measures correlated with both strength and aerobic outcomes (ρ ≈ 0.33–0.50; all p < 0.001). In regression analyses, HGSmax was the main predictor of 20RM biceps (R² = 0.792) and showed moderate predictive capacity for quadriceps performance (R² = 0.521). The MET model demonstrated limited explanatory capacity (R² = 0.288). Conclusions: The integration of simple, accessible, and reproducible tools such as HGS and the 6 MWT with morphofunctional parameters may provide a pragmatic approach to support individualized exercise prescription in cardiac rehabilitation. While stronger associations were observed for upper-limb resistance performance, the predictive capacity for lower-limb strength and aerobic exercise intensity was more moderate and should be interpreted cautiously. These findings support the potential clinical utility of combining functional and morphofunctional assessments in routine cardiac rehabilitation practice. Full article

Fragmented transit governance across multiple agencies makes measuring service inequality in large metropolitan regions notoriously difficult. This paper maps schedule-aware transit service intensity—an origin-side, supply-focused component of accessibility—across the Greater Toronto Area (GTA) by integrating General Transit Feed Specification (GTFS) data from six providers within an H3 hierarchical hexagonal grid. The measure does not capture destination access, travel time, transfers, fares, reliability, or crowding, and is therefore framed throughout as a service-intensity indicator rather than a full accessibility evaluation. We operationalize the indicator as the number of cumulative scheduled departures per hour reachable within an 800 m walking catchment for three distinct time windows: weekday peak, weekday midday, and Saturday midday. Across 9635 hexagons and 23,026 stops, our results reveal a sharply hierarchical regional network. When weighted by population, 16.4% of GTA residents have no scheduled service within walking distance during the weekday morning peak; the corresponding area-weighted share, reflecting the extensive greenbelt and agricultural fringe, is 70.6%. Only 22.6% of hexagons reach at least 12 departures per hour, while 75.5% of residents meet that threshold. Median service intensity drops from 234.25 departures per hour in the Urban Core to zero beyond the Inner Suburban Ring, and service thins out on weekends, with retention in the outer rings dropping to roughly 75% of weekday levels. Spearman correlations show that service intensity is concentrated in denser, more diverse, and lower-income census-tract contexts, with population density emerging as the strongest hex-level correlate ($\rho =0.69$); after Clifford–Richardson correction for spatial autocorrelation (effective $n\approx 745$), the principal CT-level correlations remain statistically significant ($p<{10}^{-15}$), and partial correlations controlling for density indicate that socioeconomic composition retains an independent, if attenuated, association. Under one-tract-one-observation aggregation ($n=1144$ unique tracts), the income gradient strengthens to $\rho =-0.74$ and becomes co-equal in magnitude with population density ($\rho =0.74$), confirming that the hex-level coefficients are not artifacts of pseudo-replication. A population-weighted Gini coefficient of 0.60 confirms substantial distributional inequality. Sensitivity analyses confirm that the Inner-to-Outer Suburban break is robust to alternative ring thresholds (10/25/40 and 20/35/50 km), to exclusion of the four Halton municipalities affected by incomplete local-feed coverage, to H3 resolution at the municipal level, and—in a representative shortest-path network sub-analysis for Pickering (not a full GTA-wide network-distance test)—to use of network rather than Euclidean walking distance. These patterns suggest that a substantial gap exists between where suburban residential growth has occurred and where frequent transit service is available, a pattern with historical roots in the 1996–2006 service–need alignment, though the 2006–2023 trajectory is not directly measured here. The results suggest that the transition zone between the inner and outer suburbs may warrant further investigation as a planning focus, and that cross-agency weekend service coordination merits further analysis as a potential equity dimension. This multi-agency H3 framework establishes a reproducible baseline for monitoring schedule-aware service intensity in polycentric metropolitan areas. Full article