Bringing fitness to the masses: converging interests in California.

There's a movement afoot to get more people more active more often. Certainly, this is an area of great concern and interest for park and recreation agencies. However, support is broad-based, going well beyond the realm of parks and recreation.

Air-quality agencies, transportation and planning departments, environmentalists, employers, local government and public health officials are converging on the idea that a community of physically active people will ultimately be a community with reduced traffic congestion, air pollution and health-care costs. Active people tend to be more productive at work, enjoy increased energy levels and good health; they are more likely to support activity sites -- parks, greenways, trails and open space -- in their neighborhoods.

The vision underlying these new partnerships has implications for everyone within the community. This is not a movement catering to athletes and fitness buffs. Instead, this active and healthy community is where people don't need to "find time" to "exercise;" they simply integrate activity into their usual routines -- during work, travel and leisure time. We're not suggesting a world where everyone wears spandex, buys expensive workout equipment and spends hours in front of mirrors looking at their buffed bodies. In both business and residential neighborhoods, walking and biking would be safe and convenient: the preferred modes of transportation.

Public Health's Commitment

A substantial commitment has b6,en made by federal public health agencies to encourage the development of supportive environments for physical activity. In 1996, the Surgeon General issued an attention-grabbing report on physical activity and health. The report documents how an inactive lifestyle is hazardous to one's health, to paraphrase the tobacco warning of 1964. It recommends ways communities can create "supportive environments" for currently inactive residents.

California is the first state to commit significant resources specifically to physical activity promotion. Since 1994, On The Move! at the Department of Health Services has funded nine physical activity demonstration projects to develop ways to get inactive people in ethnic minority communities "off the couch and on the move." Following the Surgeon General's report, the state (public) health department and the Institute for Health and Aging at the University of California-San Francisco hired additional staff to break new ground with environmental and policy changes. Our efforts will attempt to reproduce the extensive societal attitudes and behaviors that the tobacco movement has accomplished since 1964.

Our team, the California Physical Activity and Health Initiative, builds upon a relatively sparse history of community-based demonstration projects targeting chronic diseases, such as cardiovascular disease. Safe, attractive and convenient places for people to enjoy being active is the resounding message. We know these are factors that determine whether or not people choose physically active lifestyles. California's Initiative is taking up the challenge.

Agency Assets are Aces

Park and recreation agencies -- including staff with senior services and adapted leisure -- hold the "high cards" to re-create community norms around active living. An agency's staff and physical resources are unmatched by other community organizations. I left the California Park and Recreation Society to "build a sturdier bridge between public health and parks and recreation."

Park and recreation agencies are uniquely positioned and qualified to: (1) convene and facilitate community meetings and coalitions; (2) provide activity sites in most urban neighborhoods; (3) publicize site locations and promote their use; (4) suggest options for improving safety of sites; (5) provide programming ideas that appeal to a variety of population groups; (6) offer a wide selection of activities, increasing the likelihood of individuals finding one they enjoy; (7) offer instructors trained and certified for maximum credibility; (8) capture the involvement of community volunteers; and (9) capitalize on their (implicit or explicit) health and wellness services.

The support our Initiative can provide agencies in California will help them strategically play their winning hand by leveraging existing park and recreation resources -- the human and physical kinds -- to benefit the agency and the overall health of the community. (There is at least one person at each state health department, usually in a chronic-disease or health-promotion position, whose duties include promoting physical activity. This is the go-between for local agencies and national organizations.)

Healthy People 2000 Objectives Set Targets

A landmark article in 1993 confirmed that the actual causes of death in the United States in 1990 were tobacco use, diet and inactivity. It was these three causes that predominantly put people at risk for chronic disease, particularly coronary heart disease, adult-onset diabetes, hypertension, obesity, diminished mental health (such as depression) and certain cancers. The U.S. Department of Health and Human Services uses science-based research to determine priorities for state public health funds. The most recent objective, Healthy People 2000, identifies 12 targets specific to physical activity and health. In California, as is the case throughout the country, people are far removed from the targets for active life styles. Two objectives can illustrate why public health officials are so concerned.

Objective 1.3, Sedentary Lifestyle: Reduce to no more than 15 percent the proportion of people 6 years and older who engage in no leisure-time physical activity.

In California, 21 percent of adults in 1995 reported no leisure-time activities outside of normal work duties, and 55 percent reported having insufficient activity to gain significant health benefits. Black, Hispanic, and low-income populations were less likely to engage in leisure-time physical activity (see bar graph).

Another Healthy People 2000 objective underscores public health's interest in working with parks and recreation to develop resources.

Objective 1.11, Community Fitness Facilities: Increase community availability and accessibility of physical activity and fitness facilities. Participation in regular physical activity depends in part on the availability and proximity of community facilities and conducive environments. As the distances between facilities and residential areas increase, use generally decreases. People are unlikely to use community resources located more than a few miles away by car or more than a few minutes away by bike or on foot. In "The Prevention Index '89 Summary Report," 51 percent of adults agreed that greater availability of exercise facilities would help them become more involved in regular exercise.

Key Findings from International Research

The emphasis to get people more physically active has led to a research "bonanza" in recent years. International consensus regarding the best and most promising scientifically evaluated approaches only now exists for motivating individuals and changing social and physical environments in communities. The world is indebted to the front-runners in physical-activity promotion: England, Canada and Australia.

Over and over again, the researchers point to success when people can enjoy being active (alone or in groups) in safe, attractive, enjoyable, and convenient environments. A sampling of key findings makes it obvious why parks and recreation is key to the cause.

Safety

Personal safety is a prerequisite for ongoing participation in activities. Safety of park and recreation sites -- through lighting, group use, or neighborhood patrols -- is commonly noted as a key determinant of use. Traffic "calming" techniques, to slow motor travel on streets, motivate people to bicycle and walk on adjacent sidewalks. Sidewalks have even better use when travelers are separated from the street by landscaping and other street amenities, such as benches or shelters. Effective and long-lasting change requires attention to personal comfort in the social context, as well. Safety is found by use of existing "networks," where people are familiar with one another and have similar interests. Group leaders drawn from the existing social group may be most effective in creating a socially safe environment for their peers.

Fun & Enjoyment

The environment strongly influences our daily activities. For example, the distance that people are willing to walk can be lengthened by pleasant and interesting environments.

The greater the variety of specific programs presented, the more likely it is that people will participate. When people feel they have been given options from which to choose, they are more likely to persist with an activity. Self-efficacy (confidence in one's ability to exercise) and the support of friends and family were associated with walking for exercise among sedentary subgroups and with increased walking over a two-year period.

Convenience

A person is more likely to continue with physical activity if there is less traveling time, expenditure, and disruption of other activities required. Major innovations in exercise settings should significantly influence what people choose to do and how difficult they see maintaining regular exercise to be. Settings where people spend a large portion of their day -- work sites, residential housing developments, shopping plazas and malls, and schools-provide access to people less willing to travel to parks and other activity-specific sites. The use of telephones or home-based approaches shows promise for helping with maintaining activity.

Applying the Findings

Strong leadership is needed from park and recreation agencies in order for communities to develop activity-friendly environments. In California, better utilization of existing community resources, such as parks, schools, and multi-use trails, will be a priority strategy. That's common sense, given that the majority of communities cannot allocate funds to develop new activity sites and "active transportation infrastructure" right away. According to current thinking, however, the development of costly new facilities or infrastructure will not become a priority in the future. The emphasis will be to expand utilization of existing resources. Partnerships with community members and organizations will play a pivotal role in this process. Fortunately for all activity-friendly community advocates, the National Recreation and Park Association is committed to a substantial leadership role. NRPA's approach dovetails with and, in fact, incorporates public health science. The opportunities for highly collaborative work between parks and recreation, public health, land use/transportation planners and schools beckon as a profitable venture. NRPA has agreements ,with national organizations, such as Scholastic Magazine, Inc., BenGay[R] and the National Heart, Lung, and Blood Institute. The California Health Department is pleased to also have a formal agreement (MOU) with NRPA to pursue projects of mutual interest.

Self-Guided Activities

With "lack of time" given as the primary reason for physical inactivity, it's important for agency activities to be convenient. For many people who aren't "joiners," this means helping them with self-guided activities. The Exer-Deck was designed by the Colorado State Health Department and NRPA to meet this need. Exercise instructions and safety tips are simple to follow for use at home or at a park site. More elaborate home-based programs are being studied now by researchers. Individuals at home receive extra prompts, incentives, instruction and follow-up by phone or mail. When it comes time to implement these new models in California, we will ask recreation staff to be the consultants.

Schools

Convenience for families with children means that activities include child-care options or are held at school sites. Creative recreation programming, and not just for the children, is taking place before, during and after school hours. Local health department dietitians with Project LEAN (Low-fat Eating for America Now) work at 10 high schools around California, enacting policies to improve students' nutrition and opportunities to be physically active during the school day. Recreation agencies are seen as valuable partners in this effort.

Lay Leadership

The ON THE MOVE! projects in California reported good success when someone from the community was the activity leader. In these ethnic minority communities, adults were more likely to participate with "someone I can relate to" in charge. One project developed a training manual for lay leaders in their rural Latino community; the manual is being revised for use by other groups. Lay leadership models are being developed in senior centers, as well.

Physicians

In January 1998, three programs at the Department of Health in California (physical activity, nutrition and breast cancer early detection) will start piloting one approach to increase utilization of park and recreation services. Physicians and their office staff will be trained to counsel patients to become more active. As part of the training, they will be oriented to local recreation and activity resources in their area. For non-piloted sites, NRPA will have a standardized letter to health-care providers on the web site; agencies may attach brochures and facility maps.

Employers

In northern California, a link between recreation and work sites is in the design stage. Members of recreation programs, either from senior centers or after-school programs, have the opportunity to "Adopt-A-Stairway" at a nearby business. These groups will use their artistic talents to improve the appearance of stairways. Additional art will be placed near elevators to "prompt" people to use the stairs. The project is designed to strengthen the bond between businesses, recreation agencies and community members.

Community-Wide Coalitions

Some of these changes will be substantial, if not monumental, for most communities. A high level of cooperation and commitment will be necessary among many community partners. California will encourage communities to work through local coalitions, similar to those established for the tobacco control effort in this state. It may be possible for existing community-wide organizations, such as park and recreation commissions and boards, to embrace an active-living agenda; Park and recreation staff and volunteer citizens -- including those representing senior services and therapeutic recreation -- will be necessary leaders for these local coalitions.

Extend Benefits for Community Health and Safety

Americans, on a daily basis, are bombarded with messages to live a passive and ultimately unhealthy lifestyle. To get them "on the move" it is critical to educate them to enjoy active living. Beyond that, we must make the active choice the easy choice. Parks and recreation is the link between people and healthy communities. Agencies offer fun, beauty, safety and convenience to entire communities. Next comes extending these benefits in ways that deliberately promote community health and safety. Many partners are poised to tackle the barriers facing individuals and communities. We look to parks and recreation agencies to bring out those aces they hold and play the winning hand.

Facility                1986 U.S. Baseline     2000 Target Objective
Hiking, biking, and     1 per 71,000 people    1 per 10,000 people
fitness-trail miles

Public swimming pools   1 per 53,000 people    1 per 25,000 people

Acres of park and       1.8 per 1,000 people   4 per 1,000 people
recreation open space   (533 people/           (250 people/
                        managed acre)          managed acre)

RELATED ARTICLE: HEALTH BURDENS THAT COULD BE REDUCED THROUGH PHYSICAL ACTIVITY

13.5 million people have coronary heart disease

1.5 million people suffer from a heart attack in a given year

8 million people have adult-onset diabetes

95,000 people are newly diagnosed with a colon cancer each year

250,000 people suffer from a hip fracture each year

50 million people have high blood pressure

More than 60 million people are overweight