Community Recreation and Parks: The Benefits of a Healthy Agenda.

Health has always been the agenda of local government recreation and park services. Their whole notion of "wholesome" recreation implied 1. healthy and 2. morally worthwhile. Recreation and park services have historically aimed to provide safe opportunities for both children and adults to exercise their minds and bodies. In addition, they have attempted to reduce the stress of living in newly created urban areas by allowing the opportunity for one to sit on a park bench under a canopy of big trees.

More recently local government parks and recreation services have provided a means to revive forgotten leisure skills in older adults and provide a host of physical and social recreation opportunities adapted for individuals with disabilities and special needs. All of these health agendas have been central to recreation and parks.

This agenda, more than two centuries old, is being revitalized for the 21st century as health and health care are being rethought in ways that recognize and include community recreation and park services. The need for rethinking health and health care may be summarized as follows:

* The United States now ranks 37th in the world in the overall quality of its health care (WHO, 2000).

* About 15 percent of all money spent in the United States is for "health" purposes and, in a rapidly aging population, the ratio of spending on older people is seven to 10 times as much as for younger people (Godbey, 1998).

* Obesity is at an all-time high as one out of every three Americans is overweight (National Health and Nutrition Examination Survey III, 1988-1994).

* Approximately one-third of all American adults reports having no leisure-time physical activity (LTPA; Morbidity and Mortality Weekly Report, 1997).

* The leading causes of death are now mainly those over which individual behavior, habits, and attitudes exert some influence. While pneumonia, tuberculosis, and diarrhea or enteritis were the leading causes of death in 1900, a century later the leading causes are heart disease, cancer, and stroke. More than 80 percent of the factors that determine our state of health have to do with our environment, our relations with friends and enemies, the quality of our education, our status in the community, and how we think about ourselves (Nesse & Williams, 1996).

Behavioral factors are important because their effects can enhance quality of life, aid in chronic illness management, and may help contain healthcare costs. Leisure is an important behavioral factor that can benefit health. Therefore, local government recreation and park services can easily become involved in the health-care continuum.

The nature of community agencies makes them an ideal setting for this step in the health-care continuum. Besides being affordable, accessible, and attracting people with similarities (e.g., neighbor, life situation, age, skill level), local park and recreation agencies offer a wider variety of programs and facilities than traditional fitness facilities, such as walking trails, social activities, hobbies, trips, and other activities that involve some physical activity and socializing.

Such activities may not only provide physical exercise but may also lead to improved psychological health through improving mood and self-efficacy, increasing the desire to take on other challenges, and helping increase or maintain intelligence. The evidence is increasing that people will continue to participate in recreational activity that they enjoy. However, they will not adhere to prescription exercise for very long (Dishman & Sallis, 1994).

More recently, the Surgeon General's Report has suggested that positive health benefits can be associated with moderate levels of physical activity (as opposed to vigorous exercise). In addition, the Centers for Disease Control and Prevention along with the American College of Sports Medicine has developed new physical activity guidelines suggesting that every U.S. adult should participate in 30 minutes of moderate-level physical activity per day (Pate et al., 1995). The activity may be continuous or intermittent.

Furthermore, in the new guidelines the emphasis is on physical activity for health as opposed to physical activity for fitness, with the suggestion that schools, work sites, and communities should become involved in promoting physical activity. The suggestion to include recreation and parks as a venue for physical activity participation was previously one of the Healthy People 2000 objectives. However, the lack of documentation and outcomes-based research may have contributed to the failure in meeting the objectives. Therefore, in order to place parks and recreation in the health promotion arena, it is important to have community-based programs that document health-related outcomes.

Active Options

Active Options is one example of a community-based wellness program that offers members a variety of programs and services (e.g., exercise classes, seminars, fitness and leisure evaluation) to facilitate older adult involvement in meaningful physical activity. This program, which is sponsored by the Foothills Park and Recreation District (serving several suburban Denver communities), was conceived to meet older adults' (i.e., those 62 and over) growing need for physical activity and socialization and to establish a continuum of care between participants' physicians and a community wellness facility.

Active Options was also designed to train instructors how to help participants decrease chronic disease symptoms and increase rehabilitation opportunities and to counsel participants on the benefits of active participation in their community.

Evaluating the Program

The evaluation of the Active Options program was conducted from February through June 1999, examining program effectiveness and efficiency as well as the effects of program participation on selected health and psychosocial outcomes such as perceived physical and mental health, self-efficacy, and social support. The National Recreation Foundation sponsored the research with the assistance of faculty in both recreation and parks and biobehavioral health from Pennsylvania State University and Kent State University.

The research design involved in-depth interviews, a pilot study, a mailback questionnaire, and evaluation of physical data. Both current members and those who had dropped out of the program were examined. Topics of inquiry included member behaviors, how they found out about Active Options and why they joined, benefits received, their rating of the program, use of other Foothills programs and facilities, demographic profile, perceived health, daily physical activity, lifestyle behaviors, and psychosocial characteristics such as self-efficacy, social support, and stress levels.

Findings

Those individuals studied ranged in age from 50 to 88 years old with an average age of 69. Three-quarters were women, most were white and relatively well educated. Thirty percent of respondents indicated that they had a disability, most commonly sensory impairments, knee problems, and back problems. People heard about the program primarily through word of mouth, the seasonal brochure, and from friends, although local health maintenance organizations and physicians who were aware of the program also referred participants.

What participants said they liked about the program would seem to indicate that Active Options would have wide appeal in communities all over the country. People liked:

* Low cost of the program.

* Instructors who were helpful and knowledgeable.

* The times the program was offered.

* Clean and well-maintained areas and equipment.

* Fitness equipment was available.

Those who continued in the program gained significant health benefits compared to those who dropped out. As well as having fun with friends, their health benefits included:

* Two less visits to a doctor for treatment of a health problem.

* One less nights stay in a hospital.

* Better perceived health.

* Increased self-efficacy -- the belief that one can complete specific tasks.

In addition, participants in the Active Options program had some significant physical differences over time:

* Improved cardiovascular fitness (decreased heart rate and blood pressure and increased aerobic fitness).

* Improved back flexibility.

* Increased muscular strength.

The results from this study suggest that physical activity participation in a community can be associated with health benefits. This relationship can be shown by a model proposed by Bouchard and Shephard (1994), which links physical activity, fitness, and health. This model specifies that physical activity (exercise, occupational or household tasks, leisure) influences health-related fitness (body mass index, body composition, flexibility, muscular strength, aerobic capacity, heart function), which can affect health (a continuum from wellness to mortality that includes frailty and physical function).

This model demonstrates that there are also reciprocal interactions in the relationships between physical activity and health. As such, frailty may affect one's physical activity, which may influence health-related fitness. Furthermore, personal, social, lifestyle, and environmental factors are individual characteristics that can influence physical activity, health-related fitness, or health.

With older adults, the physical environment plays a role in physical activity participation. It may be that the health club setting can be intimidating for older adults, therefore acting as a barrier to participation in physical activity. In addition, one's neighborhood may influence participation. If one does not feel comfortable in the physical environment, then participation will not occur.

Social interaction with peers is vital to physical activity participation and health. In a community-based physical activity program such as Active Options, the older adults can interact with their peers in a comfortable, safe setting, which can promote adherence to activity and positive health.

As the link between community-based services such as recreation and parks is increasingly understood by those in public health, HMOs, and the medical community, programs such as Active Options will be recognized as critical resources in improving and maintaining the health of older members of the community.

The mission statement of this working group is to improve individuals' health through the development of an infrastructure that establishes low-cost, inclusive, pleasurable, community-based programs to enhance the quality of daily life. By the establishment of a health-based infrastructure and system of delivery in community-based programs, within five years 80 percent of all agencies (N = 6500) represented by NRPA will have exposure to such a program. The future vision includes establishment of a national database that can be used to help document health outcomes associated with participation in a program.

Visions in five years:

* Will be able to show evidence of personal health benefits from participation in programs.

* Will influence health policy.

* Will have standards of practice.

* Will be recognized for work with youth and older adults.

* Will be cited as a part of Healthy People 2020.

* Will be a force in facilitation of national strategies for interdisciplinary approaches to addressing health issues.

* We will be able to have a profile of participants in terms of social changes, behavior change, and lifestyle change.

In summary, we hope to assist communities in establishing physical activity promotion programs and provide a means by which to document health-related outcomes. Successful implementation of these programs will then allow parks and recreation programs to have a demonstrated impact on Healthy People 2010 objectives.

Active Options

Active Options was implemented into the Foothills (Lakewood, Colo.) Parks and Recreation system in 1997. The reason behind the implementation came from the reality that seniors appreciate and benefit from a cost-conscious, high-quality fitness experience that increases health and is right in their own community.

Seniors in Lakewood united behind Active Options, paying $149 annually to have the freedom to choose between 12 classes, unlimited facility usage, free fitness consults, twice yearly newsletters, and a staff trained in how to effectively utilize parks and recreation programs to combat the symptoms of chronic illness (arthritis, osteoporosis, depression, pulmonary complications and cardiac disease).

After three years the entire budget for Active Options was balanced and 435 members were actively reaping the benefits. "When folks only have to drive five minutes to work out with their friends and have quality staff help them, plus other opportunities to socialize and physically get stronger, why wouldn't they keep joining?" asks Chris Katzenmeyer, Active Options coordinator. "Parks and recreation staff and facilities are a secret that needs to be shouted about to more older adults and the clinical community. There is more rehab going on in these facilities than in any hospital around."

When the administration of the district was asked to reflect on the 10 most significant contributions of the Active Options program to their agency, the following list was provided.

1. Better marketing posture for the agency.

2. Organized and vocal voter base.

3. Local acknowledgement of innovative programming.

4. Opportunities for increased partnership.

5. Increased credibility as a means to sustaining good health at a reasonable cost.

6. Strong senior programming and outcome data lead to increased funding through sponsorships, grants, and scholarships for low-income users.

7. Innovative projects encourage higher-quality employees.

8. Older citizens want better wellness/ recreation facilities, thus encourage construction and bond issues.

9. People involved in the Active Options program use other programs and facilities, as well as volunteer for the district.

10. It's just good business to create environments promoting healthy seniors.

References

Bouchard, C., & Shephard, R. J. (1994). Physical activity, fitness, and health:the model and key concepts. In C. Bouchard, R. J. Shepard, & T. Stephens (Eds.), Physical Activity, Fitness, and Health:International Proceedings and Consensus Statement (pp. 77-88). Champaign, IL: Human Kinetics.

Dishman, R. K., & Sallis, J. F. (1994). Determinants and interventions of physical activity and exercise. In C. Bouchard, R. J. Shephard, & T. Stevens (Eds.). Physical activity, fitness, and health: International proceedings and consensus statement (Vol. 1, pp. 214-238). Champaign, IL: Human Kinetics.

Godbey, Geoffrey C. Outdoor Recreation: A Reader for Congress. Prepared for the Senate Committee on Energy and Natural Resources. Library of Congress, June, 1998. re-printed two articles and testimony to Senate Committee on Energy and Natural Resources.

Montague, P. Rachel's Environmental and Health Weekly (On-line serial). Available http://www.rachel.org

Neergaard. US Health Care Costs Rank High. Associated Press. June 21, 2000. World Health Organization.

Nesse, R. and G. Williams. 1996. Why We get Sick -- The New Science of Darwinian Medicine. New York: Vintage Books.

Ornstein, R., and Sobol, D. (1987). Healthy Pleasures. New York, NY: Addison-Wesley.

Pate, R. R., Pratt, M., Blair, S., Haskell, W., Macera, C. A., Bouchard, C., Buchner, D., Ettinger, W., Heath, G. W., King, A. C., Kriska, A., Leon, A. S., Marcus, B. H., Morris, J., Paffenbarger, R., Patrick, K., Pollock, M., Rippe, J. M., Sallis, J., & Wilmore, J. H. (1995). Physical activity and public health: a recommendation from the Centers for Disease Control and prevention and the American College of Sports Medicine. JAMA, 273(5), 402-7.

While parks and recreation is virtually synonymous with fun and games, it's actually another benefit -- health promotion -- that's catching the attention of those in the medical community and positioning programs such as Active Options as critical resources in improving and maintaining the health of older adults. Active Options, a community-based wellness program that gets seniors involved in meaningful physical activity, is sponsored by the Foothills Park and Recreation District in Colorado. It was designed to meet older adults' need for socialization and activity. What authors Beth Orsega-Smith and Geoffrey Godbey of Pennysylvania State University, Laura Payne of Kent State University, and Foothills' Chris Katzenmeyer found participants liked about the Active Options program -- low cost, helpful instructors, accessibility -- would appeal to communities across the country (p. 68).