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Physical Activity: Park, Trail, and Greenway Infrastructure Interventions when Combined with Additional Interventions

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What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on a systematic review of 38 studies (published through July 2020). Twenty-one of the studies evaluated infrastructure interventions when combined with additional interventions. Studies were identified from two sources:

  • Studies included in a broader systematic review published in 2019 (Hunter et al., 14 studies, search period through August 2016)
  • Studies identified in an update search (7 studies, search period August 2016–March 2019)

The systematic review was conducted on behalf of CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to physical activity and the built environment.

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review included 21 studies that evaluated infrastructure interventions combined with additional interventions.

  • The number of people engaging in moderate-to-vigorous physical activity increased by 17% (7 studies).
  • The number of people using the park, trail, or greenway increased by 18.3% (9 studies).

Across all 21 studies, changes in physical activity were generally favorable for the following outcomes:

  • Moderate-to-vigorous physical activity in the park, trail, or greenway (11 studies)
  • Total physical activity (4 studies)
  • Physical activity meeting recommended levels (4 studies)
  • Other measures of physical activity (8 studies)

Summary of Economic Evidence

A systematic review of economic evidence has not been conducted.

Applicability

Based on results from this review, findings should be applicable to urban and suburban communities in the United States. The CPSTF finding is likely applicable to interventions implemented in racial and ethnic minority communities.

Evidence Gaps

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

  • How effective are infrastructure improvements, in combination with additional interventions, in improving the following outcomes?
    • Fitness
    • Mental health including measures of anxiety, depression, and well-being
    • Perceptions of social cohesion and connectiveness
    • Injuries
    • Quality of life
  • How effective are infrastructure improvements in combination with additional interventions when implemented in the following?
    • Rural or indigenous settings
    • Communities with lower incomes
  • Which characteristics of infrastructure improvements are consistently effective in increasing physical activity and use (e.g., signage and other wayfinding aids, park-based trails, indoor or outdoor fitness centers, ball fields and courts, skateparks)?
  • Which additional interventions or combinations (e.g., programming, access, promotion of use or community engagement) are most effective at increasing physical activity and use?
  • How effective are park, trail, and greenway infrastructure improvements in combination with additional interventions in reducing perceptions of crime, and improving perceptions of safety among members of the community?
  • Which interventions or combinations are most effective in addressing barriers to use of parks, trails, and greenways by older adults or in communities with lower incomes?

Study Characteristics

  • Study designs included randomized controlled trials (1 study), other designs with a concurrent comparison group (10 studies), before-after designs with a comparison group (4 studies), time-series (2 studies), and before-after designs without a comparison group (4 studies).
  • Studies were conducted in the United States (14 studies), Australia (3 studies), the United Kingdom (2 studies), Canada (1 study), and the Netherlands (1 study).
  • Studies were conducted in urban communities (10 studies), urban and suburban settings (5 studies), suburban communities (2 studies), and a rural community (1 study).
  • Park infrastructure improvements noted in the studies included new structures (8 studies), renovations to existing structures (8 studies); and the addition of signage (2 studies).
  • Greenway and trail infrastructure improvements included new greenways or trails (6 studies), a trail extension (2 studies s), and the addition of signage (1 study).
  • Additional interventions noted in the studies included access enhancements (13 studies), community engagement (7 studies), additional programming (4 studies), and promotional activities (4 studies).