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

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends park, trail, and greenway infrastructure interventions when combined with additional interventions to increase physical activity. Evidence from the systematic review shows these interventions increase the number of people who engage in moderate-to-vigorous physical activity in the park, trail, or greenway. Studies also show increases in the number of people who use the park, trail, or greenway.

There were no economic studies that evaluated park, trail, and greenway infrastructure interventions when combined with additional interventions. However, CPSTF finds the economic benefits exceed the cost for park, trail, and greenway infrastructure interventions when implemented alone.

CPSTF finds insufficient evidence for park, trail, and greenway infrastructure interventions when implemented alone.

The full CPSTF Finding and Rationale Statement and supporting documents for Physical Activity: Park, Trail, and Greenway Infrastructure Interventions to Increase Physical Activity are available in The Community Guide Collection on CDC Stacks.

Intervention

These interventions combine infrastructure interventions with one or more additional interventions. Park, trail, and greenway infrastructure interventions improve the built and natural environments by creating or enhancing public locations for physical activity, relaxation, social interaction, and enjoyment. Locations include the following:

  • Parks designated public areas that often combine greenery with paths, facilities for physical activity and recreation, and places for relaxation and social interaction
  • Trails and Greenways routes for walking, hiking, or cycling in urban, suburban, or rural areas (e.g., “rails to trails” conversion projects). These may involve street conversions that provide opportunities for walking and cycling (most often in urban areas).

Additional interventions include the following:

  • Community engagement to ensure community participation in intervention planning
  • Public awareness activities (e.g., banners, flyers, promotional campaigns, event days)
  • Programs that offer structured opportunities for physical activity and social interaction (e.g., walking groups, exercise classes, organized sports)
  • Access enhancements including transportation connections, street crossings, and expanded hours of operation

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)

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), 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)

Summary of Results

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 from the societal perspective shows the economic benefits exceed the cost for park, trail, and greenway infrastructure interventions. The systematic economic review did not find any economic studies of parks, trails, and greenways with additional interventions.

The review included 8 studies (search period through March 2022) that evaluated the infrastructure component of interventions. Monetary values are reported in 2021 U.S. dollars.

  • The median one-time capital cost was: $8,679,850 (7 studies)
  • The median annual maintenance cost was: $34,570 (7 studies)
  • The median annual benefit was: $994,000 (7 studies)
  • The cost per disability-adjusted life year (DALY) averted was: $23,254 (1 study)
  • The median benefit to cost ratio was: 3.1 (7 studies)

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

  • 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?
  • What is the cost-effectiveness of park, trail, and greenway interventions?
  • What are the economic effects of neighborhood displacement on residents from historically disadvantaged racial and ethnic populations and populations with lower incomes?

Implementation Considerations and Resources

Parks, trails, and greenways are modifiable social determinants of health (Healthy People 2030). Studies and implementation guidance identified in the broader literature described public health and community opportunities to engage in the planning, allocation, and evaluation of these community improvements and advance health equity.

  • Equitable park access can be defined as the just and fair quantity, proximity, and connections to quality parks, as well as programs that are safe, inclusive, culturally relevant and welcoming to everyone. To achieve this, health equity principles can be used to guide park priorities and investments in ways that involve and sustainably benefit communities
  • Equity-based park guidelines emphasize cross-sector partnerships, community engagement, and strategic data collection and analysis

Implementation guidance incorporating equity considerations is available from several organizations:

The National Recreation and Park Association advocates for parks and recreation with emphasis on health and wellness, equity, and conservation.

The Trust for Public Land works to create recreational spaces and provides a tool kit for collaborating with communities in the development of parks.

The Safe Routes Partnership provides fact sheets, toolkits, and infographics to help communities implement active travel to parks.

The Rails to Trails Conservancy provides implementation and equity guidance relevant to trails and greenways.

The City Parks Alliance is a network of leaders in urban parks and recreation that shares research and tools, including those promoting health equity and environmental practices.

Healthy Places by Design works to advance community-led action. They provide reports and action guides for local government leaders and organizations.

The Prevention Institute has developed a toolkit for community-based organizations.

Park, trail, and greenway interventions may be linked or coordinated with other elements of the built environment including two CPSTF-recommended approaches to increase physical activity:

Greening-without-Gentrification [PDF — 2.6 MB] proposes strategies to prevent or reduce the possible harms of gentrification or displacement of current residents following the establishment of large parks, trails, or greenways.

Crosswalks

Healthy People 2030 iconHealthy People 2030 includes the following objectives related to this CPSTF recommendation.