Promoting active living: why public health needs parks and recreation.

Scholars in ancient Egypt and Greece first observed the significance of places and spaces for promoting recreation and physical activity. For example, the Egyptians believed recreation was essential to one's recovery from illness and trauma. The Greeks viewed it as critical to learning and good health. And the father of American landscape architecture, Frederick Law Olmsted, believed that the primary purpose of places like parks is to provide the best means of healthy recreation for everyone.

Unfortunately, modern Western civilization hasn't followed these beliefs; today, most built environments encourage sedentary lifestyles. Technological advances, auto-oriented community design and the human desire for convenience are barriers to active living, a way of life that integrates physical activity into daily routines. Automobiles, computers, televisions and a host of other gadgets have also contributed to engineering a lifestyle that's sedentary and unhealthy.

In 1996, the U.S. Surgeon General released a landmark report, "Physical Activity and Health," which concluded that a sedentary lifestyle is a primary factor in more than 200,000 deaths per year. This is equivalent to approximately 25 percent of all chronic disease deaths and 10 percent of all deaths in the U.S. Cardiovascular disease, diabetes, hypertension, obesity, osteoporosis and some cancers are all linked to a sedentary lifestyle.

Why should this apparent public health issue be important to park and recreation professionals?

Support Parks, Support Health

Public health professionals now know that new approaches to promoting physical activity must originate from additional but complementary disciplines such as parks and recreation. One viable approach to increase physical activity levels is to develop policies and programs that support park, trail, and greenway development and use. Some park advocates support this approach, suggesting that when communities invest in parks and other recreational facilities, they invest in the health of their citizens. Public health officials are now ready to explore the idea that community design, along with the availability of parks, trails and greenways, can have a positive impact on community health.

Current evidence supports the hypothesis that activity-friendly environments contribute to physically active lifestyles and healthier communities. The literature also suggests that existing community design and transportation systems often neglect pedestrians and bicyclists. Lack of facilities and poor connectivity with destinations of interest can make safe and convenient walking and bicycling to places such as parks and trails difficult, if not impossible.

A growing body of literature suggests that, by creating choices for transportation and recreation, we can effectively address a number of issues confronting our society, such as traffic congestion, air quality and other quality-of-life issues. Building and supporting active living environments is one way to provide greater opportunities for routine physical activity. In an active living environment, one doesn't have to plan where to have physical activity; rather, the provisions for physical activity are readily and safely available in the surrounding environment. In other words, in an active living environment, opportunities to be physically active are present when one walks out of the front door of the home, office or school.

Current research suggests that parks and trails can promote physical activity. In a survey of U.S. adults, of people using a park or walking and jogging trail, almost so percent reported an increase in activity since they began using these facilities. Similarly, in a Missouri survey, 55.2 percent of people using trails reported an increase in walking since they began using the trails. Women and people with a high school education or lower were more than twice as likely to have increased their amount of walking since they began using the trails. This study also found that walking trails might be beneficial in promoting physical activity among women and people in lower socioeconomic groups.

Communities that are interested in promoted active living through the use of parks, trails and greenspace should understand the importance of access to destinations of interest (schools, shops, community centers and workplaces); the perceived safety (crime and traffic) of the space and setting; and the appropriateness of the park, trail or green-space. Considering these factors will increase the likelihood that the use of these facilities is safe, convenient and enjoyable.

The issue of safety is important to consider, especially when promoting active living in low-income communities, where high rates or the perception of criminal activity may discourage residents from walking on a trail or in a park. Data from a five-state study suggest that physical activity rates were more than twice as high among those perceiving their neighborhoods to be safe.

As this list of factors suggests, there are a number of matters to consider when creating environments conducive to active living. For such efforts to be successful, different disciplines must work together. An ideal partnership would be one that includes public health and parks and recreation.

Positive Partnerships

The need for partnerships between public health and parks and recreation professionals is an easy case to make: obesity rates are rising, and most adults are physically inactive. Options to promote routine physical activity are needed now more than ever, and research shows that the presence of parks and trails can encourage people to get moving. Creating and sustaining an active living partnership is a tremendous opportunity because collective action will build much-needed synergy and advance the complementary missions of public health and parks and recreation.

Parks and recreation professionals supply the "means" to the "end" that public health advocates seek: active people and healthier communities. To obtain maximum benefit from parks and trails, however, collaboration among numerous disciplines must occur. Parks, trails and public health professionals should reach out to those in planning, transportation, development, education and architecture, among others. Parks, trails and greenways shouldn't exist in isolation. At best, all three should be fully integrated into a community.

Full integration requires participation from various disciplines. For example, transportation planners can help recreation planners connect parks and trails with various land uses so that both are utilized as modes of transportation. Similarly, public health and parks and recreation professionals can work with local employers to provide on-site bike racks, as well as onsite facilities for their employees to shower and change into work clothes. Although initially these changes may occur primarily at the directive of employers, future zoning codes may be more proactive and mandate, for example, that worksites provide some level of bike parking.

Partnerships with local businesses are also necessary. For example, if a merchant has a number of customers who reach his or her business by biking on a park or trail, he or she should be educated on the benefits of offering bike parking or advocating for more pro-bike or pedestrian ordinances. Medical providers can also be beneficial business partners. More physicians are prescribing physical activity to their patients. Increasing physicians' awareness of local facilities such as parks and walking trails would allow such prescriptions to be more specific, and make it easier for the patient to obtain physical activity. Such outreach could be accomplished by producing materials such as a brochure that highlights park and trail locations. As these examples illustrate, partnership opportunities are nearly limitless.

Show Me the Money

Given the condition of state and local budgets and the fact that park programs tend to suffer during budget cuts, it becomes all the more vital that parks and recreation professionals seek the support of public health officials in advocating for the importance of parks and recreation programs. In fiscally tight times, public projects that are considered "amenities," such as parks, are often the first to be eliminated from budgets. Public health professionals lend credibility by researching and documenting the positive health impacts of parks and trails. Thus, health professionals are needed as advocates for parks and trails at the policy, political and project levels. They should also be at the table for discussions between park planners and other entities.

This is the primary reason why The Robert Wood Johnson Foundation established a $16.5 million national program called Active Living by Design, which provides leadership in promoting environments that offer choices for active living. Its mission includes creating and supporting the vision of active Americans in healthy communities.

The primary focus of Active Living by Design will be to fund 25 community partnerships to promote changes in community design, transportation and architecture that make it easy for people to be physically active. These partnerships will develop and implement strategies that increase opportunities for and remove barriers to routine physical activity. The success of this program hinges on public health professionals reaching out to others in disciplines with whom they have rarely, and in some cases never, worked.

Another important focus of Active Living by Design is encouraging public health professionals to try new approaches to promoting physical activity. Public health programs aimed at combating sedentary lifestyles have had a limited impact, and levels of physical activity haven't changed significantly in the past two decades. Emerging research suggests it may be more effective to develop approaches that allow people to integrate physical activity into their daily routines--a philosophy mirrored in the active living concept. For active living to permeate communities throughout the country, more emphasis must be placed on the built environment characteristics associated with physical activity (e.g., parks, walking trails, bike paths and sidewalks) rather than focusing solely on individual behavior. The task of promoting active living environments is too important for one discipline or group to address alone, which is why Active Living by Design places such a strong emphasis on interdisciplinary partnerships. For more information on Active Living by Design, see www.activelivingbydesign.org.

The Road Ahead

The major challenge is reaching the 70 percent of adults who aren't achieving the Centers for Disease Control and Prevention's recommendation for physical activity (30 minutes of moderately intense physical activity at least five days per week). Parks, trails and greenways are an important part of an effective prescription for most sedentary people. Many people believe it's impossible to solve the public health dilemma of physical inactivity through community design. This belief may exist because we continue to operate within the vacuum of our respective disciplines and fail to recognize the potential success of multidisciplinary collaboration. To increase physical activity and advance active living, we need to make sweeping changes in our approaches, and seek to develop more synergy in advancing the mutually beneficial interests that impact our respective disciplines.

Professionals from a variety of fields need to recognize their role in the larger scheme of public health and understand that their practices can affect the behavior and health of everyone. The planner, developer, architect, engineer, parks and recreation professional, and public health practitioner must work collaboratively to identify the effects of their decisions and ultimately strive to connect all of the disciplines to develop healthier communities. In essence, we're all public health practitioners and gatekeepers to the health of our communities. Public health needs you more than ever. So the question now is: What will your role be in the active living movement?

Richard Killingsworth, M.P.H., is director of Active Living by Design, which is part of the University of North Carolina's School of Public Health, located in Chapel Hill. Keecia James, M.U.P., is project officer for Active Living by Design. Hugh Morris, M.A., is research director for the Rails-to-Trails Conservancy, in Washington, D.C. For more information about the studies referenced in this article or about Active Living by Design, write to Killingsworth at [e-mail].