LOCAL PARKS AND RECREATION: FOR THE HEALTH OF IT.

Local park and recreation agencies seem well positioned to align themselves as part of the health care system.

Local recreation and park services are on the cutting edge of change. Of course, this is nothing new. Public leisure services have continuously reinvented themselves to address the salient issues of the day, whether they be physical fitness, the need for nature, the problems of inner-city youth, socialization, strengthening the family, or opportunities for play or creative self-expression.

Today many factors have combined to create a new role for local government recreation and park services: inclusion into the health care continuum. Consider first the changing situation in the United States with regard to aging:

* The percentage of elderly people in the population will increase from 12 percent to almost 20 percent over the next 25 years (U.S. Census Bureau, 1999).

* About $15 of every $100 that trades hands in the United States is for health expenditures (Nesse & Williams, 1996).

* The ratio of health care spending on the elderly compared to adolescents is anywhere from 7:1 to 10:1 (Nesse & Williams, 1996).

* Although people are living longer, the prevalence of chronic illness is rising, threatening quality of life and placing additional demands on the health care system. According to the Public Health Service (Teague et al., 1997), 80 percent of people over 65 have one chronic illness; 50 percent have two or more.

These situations require the rethinking of health care and the maintenance of health. The issues are three-fold: prevention of negative health, transition from formal rehabilitation services to accessible and affordable community health maintenance, and the design of programs that address the documented determinants of adherence to wellness programs (Dishman, 1994; King, 1997).

The three categories of determinants are:

* Program: Convenience, cost, variety, intensity.

* Environment: Accessibility, city/neighborhood design, social environment.

* Personal: Demographics, skills, attitudes, behaviors.

According to the following, public recreation and park agencies are going to play a key role in all of these issues.

* Local parks and recreation agencies are widely accessible to older people. In both the United States and Canada, more than 70 percent of respondents from national studies had a local park within walking distance of their home (Godbey, Graefe & James, 1993; Godbey, Roy, Payne & Smith, 1998; Harper, Neider & Godbey, 1997). Furthermore, the vast majority of older people currently use local parks and recreation services in their community. For instance, in northeast Ohio, 40 percent of survey respondents reported visiting local parks frequently, 50 percent visited occasionally, and only 10 percent reported no use of local parks (Godbey et al., 1998).

* Local parks and recreation services are affordable. Results from a recent study of a senior wellness program revealed that out of 18 program features, affordability was rated as the most important feature of the program (Orsega-Smith, Payne & Godbey, 1999).

* Local park and recreation agencies provide opportunities for older adults to interact with their peers. This interaction may lead to enhanced feelings of belonging, which have been associated with improved health (Cohen, 1988). In addition, such social support is an important factor in adherence to health behaviors (Hawley, 1988).

Thus, from both a financial and social perspective, local park and recreation agencies seem well positioned to align themselves as part of the health care system. Results from a recent study sponsored by NRPA in cooperation with Cleveland Metroparks provide more empirical support for this assertion.

* Older park visitors were diverse in terms of their socio-economic status, age, and ethnicity, demonstrating that parks are used by a broad cross section of older people.

* Average length of park stay was two hours. For a majority of respondents, more than half of that time was spent walking. Most older visitors were physically active while in the park. More than two-thirds used the park to obtain light to moderate levels of physical activity (Godbey et al., 1998).

* Park use was positively linked to several health measures. Specifically, level of physical activity was inversely related to body mass index and diastolic blood pressure. Level of physical activity in the park was an even better predictor of diastolic blood pressure than age. Perhaps surprisingly, education and general level of daily physical activity were not significant predictors of diastolic blood pressure (Godbey et. al., 1998).

* Park activity type was a positive predictor of the perceived ability to perform activities of daily living (ADLs). Park activity type was better than age for predicting ADL score (Payne, Orsega-Smith, Roy & Godbey, 1998).

* Frequency of park visits was positively related to a general rating of perceived health (Godbey et al., 1998).

* Older adults who use local parks have been found to make fewer visits to a physician for reasons other than a checkup, even when controlling for the effects of age, income, and health status (Godbey et al., 1998).

* The benefits that older users ascribe to their park visits are clearly health-related. The most frequently reported benefits were related to exercise, stress relief, improved mood, interaction with nature, and health (Godbey et al., 1998; Godbey & Blazey, 1983).

As local government recreation and park services become more centrally involved in health care, a major issue will be long-term health promotion and maintenance. The progression in recovery from a major health event may reflect the following sequence:

1. A traumatic health event (e.g., heart attack).

2. Medical treatment (e.g., bypass surgery).

3. Clinical rehabilitation (e.g., in- and out-patient physical and occupational therapy, therapeutic recreation).

4. Community-based health promotion/ disease prevention program (e.g., physical activity and social program sponsored by recreation and park department).

5. Recreation and park participation (e.g., participation in public recreation and park services).

The transition from supervised outpatient rehabilitation to community health promotion programs and services is critical to the completion of the rehabilitative process (e.g., physical activity prescriptions) and long-term health maintenance.

The nature of community agencies makes them an ideal setting for this step in the health care continuum. Besides being affordable, accessible, and attractive, local park and recreation agencies offer a wide variety of programs and facilities.

Community agencies extend beyond exercise into many interest areas such as fine and performing arts, hobbies, trips, special events, and social activities. Many of these broader recreational activities also involve some level of physical activity and social interaction and may facilitate other psychological outcomes -- self-sufficiency or improved mood, for example -- which may lead to improved health.

Such leisure-time physical activity, as opposed to prescribed exercise, may also be more intrinsically enjoyable and satisfying, thereby increasing adherence to physical activity and contributing to improved health and well-being.

For an older person who is recovering from a health problem, initial involvement in community recreation and park services may be limited to physical activity programs. However, to ensure long-term adoption of enjoyable physical activity, recreation and park staff could conduct individualized or small-group leisure education/counseling sessions. In these sessions, staff could help older people identify and encourage involvement in other self-chosen, meaningful, enjoyable, and beneficial sponsored recreational activities.

As previously described, a recovering older adult would advance through a continuum of involvement, from painful, worklike, and necessary as a means to an end, to activity that is chosen and pleasurable (Fig. 1).

[Figure 1 ILLUSTRATION OMITTED]

NRPA is playing an increasingly large role in ensuring that public recreation and park agencies are recognized as a part of the health care continuum. NRPA has been working with the Centers for Disease Control and Prevention and the National Heart, Lung, and Blood Institute to position parks and recreation as supporters of grassroots health promotion strategies in the eyes of the medical community and allied health promotion organizations.

Currently, NRPA and NHLBI are engaged in a demonstration project with 12 North Carolina communities to increase public awareness of heart-healthy activities. The goal is to use research-based methods and information to deliver effective programs at a local level.

NRPA is also collaborating with researchers from Pennsylvania State University and staff from the Foothills (Colo.) Park and Recreation District to evaluate a unique senior wellness program called Active Options. While Active Options is accessible, affordable, and offers much variety, the program has been taken a step further, incorporating fitness testing, many adapted exercise classes, and individual leisure counseling/advising.

There is a special scholarship program for women with breast cancer, which is a part of outpatient rehabilitation and health maintenance. In addition, Foothills is cooperating with Kaiser Permanente and other health organizations to promote the program to their clients. The HMO has also provided fitness instructors free training on chronic conditions.

Furthermore, the Foothills staff provides personalized service to Active Options members. Through their philosophy of service, mission, and goals, they have facilitated the development of a strong positive image, identity, and culture within Active Options and the communities served by Foothills. Besides evaluating the overall program and its effect on the well-being of members, NRPA, Foothills, and Penn State are working to develop a resource manual for planning, implementing, and evaluating these types of wellness programs in other local recreation and park agencies.

Recognition of the potential value of park and recreation agencies has been growing among health promotion groups. Historically, health promotion initiatives have been managed in a "top-down" format. Park and recreation systems provide the infrastructure, facilities, and reach to build national initiatives on a broader scale, from the bottom up. Moreover, park and recreation systems, with their pre-existing collaborative relationships with community organizations, can serve as a key catalyst and facilitator for health promotion programs.

The time is dawning when the nationwide network of local park and recreation systems will be recognized for its potential as a core element of the health promotion framework. NRPA and the more than 5,000 park and recreation departments nationwide are building toward this new era with energy and enthusiasm.

Organizations that are interested in senior health and wellness are encouraged to share their resources with us. To join the campaign to recognize local parks and recreation's involvement in the health care continuum, please contact:

Kathy J. Spangler, CLP
Director, National Programs
National Recreation and
Park Association
22377 Belmont Ridge Rd.
Ashburn, VA 20148
[phone]
[e-mail]

References

Cohen, S. 1988. "Psychosocial Models of the Role of Social Support in the Etiology of Physical Disease." Health Psychology 7 (3): 289-97.

Dishman, R., and J. Sallis. 1994. "Determinants and Interventions of Physical Activity and Exercise" (In C. Bouchard, R. Shepard, and T. Stephens Physical Activity, Fitness and Health:

International Proceedings and Consensus Statement). 214-38. Human Kinetics: Champaign, III.

Godbey, G., and M. Blazey. 1983. "Old People in Urban Parks: An Exploratory Investigation." Journal of Leisure Research 15 (3): 229-44.

Godbey, G., A. Graefe, and S. James. 1993. "Use and Benefits of Local Recreation and Park Services." Parks & Recreation 1 (27): 39-43.

Godbey, G., M. Roy, L. Payne, and E. Orsega-Smith. 1998. Final research report for the health and park use study. University Park, Pa.: Pennsylvania State University

Harper, J., D. Neider, and G. Godbey. 1996. "The Use and Benefits of Local Government Recreation and Park Services in

Edmonton, Alberta." Winnipeg: Health, Leisure and Human Performance Institute, University of Manitoba..

Hawley, P. 1988. "Health Practices and Perceptions of Social Support in Persons over Age 60." Journal of Applied Gerontology 7 (2): 205-30.

King, A. 1997. "Intervention Strategies and Determinants of Physical Activity and Exercise Behavior in Adult Older Men and Women." World of Review of Nutrition and Dietetics, 82, 148-158.

Orsega-Smith, E., L. Payne, and G. Godbey. 1999. Research report for the Foothills Active Options program. University Park, Pa.: The Pennsylvania State University.

Payne, L., E. Orsega-Smith, M. Roy, and G. Godbey. 1998. "Influence of Park Use on the Health of Older Adults." Annual Meeting of the Gerontological Society of America. Philadelphia.

Teague, M. L., V.L. McGhee, D.M. Rosenthal, and D. Kearns. 1997. Health Promotion: Achieving High-Level Wellness in the Later Years (3rd ed.) Dubuque, Iowa: Brown and Benchmark.

U.S. Census Bureau. 1999. "Sixty-Five plus in the United States." www.census.gov/ socdemo/www/agebrief/html/

RELATED ARTICLE: The Active Options Project

The Active Options project is a collaboration of research and community programming. The National Recreation and Park Association, Pennsylvania State University, and Foothills Parks and Recreation in Lakewood, Colo., have partnered to document the effect of a recreation facility-based fitness/wellness program for adults 60 and older.

"Recreation is making the leap to marry community recreation programming to the clinical needs of our older adults in this project. It's the perfect time to organize cost-effective methods of health care delivery in the recreational setting. It's simple, a lot of fun for participants, and making a huge dent in the health of older adults," says Chris Katzenmeyer, director of the Active Options program at Foothills.

The results of the research will be included in a manual explaining how to establish a similar program. The manual will include the following information:

* What core fitness classes in a recreation facility will most effectively address osteoporosis, arthritis, breast cancer, hypertension, depression, and cardiac disease prevention in older adults?

* How to measure and market fitness programs for seniors.

* How to collaborate with local and national health agencies, institutions, and foundations to promote health for older adults.

* How to set up an Active Options program in your facility with details regarding budgets, instructor training, equipment, marketing, facilities, liability, and partnerships.

A number of situations -- among them the aging of our population -- have emerged to make necessary the rethinking of health care and the maintenance of health. In "Local Parks and Recreation: For the Health of It," authors Laura Payne, Ph.D., an assistant professor in the school of exercise, leisure, and sport at Kent State University; Elizabeth Orsega-Smith, M.S., a doctoral candidate in the department of biobehavioral health at Pennsylvania State University; Geoffrey Godbey, Ph.D., a professor of leisure studies at PSU; and NRPA's Spangler consider parks and recreation's inclusion into the health care continuum. Citing issues of accessibility, affordability, and opportunity for peer interaction, older Americans are increasingly turning to the services of local park and recreation agencies, which continue to position themselves accordingly (p. 72).3