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

Summary of CPSTF Finding

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.

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

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

CPSTF Finding and Rationale Statement

Read the full CPSTF Finding and Rationale Statement for details including implementation issues, possible added benefits, potential harms, and evidence gaps.

Promotional Materials

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).

Analytic Framework

Effectiveness Review

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Summary Evidence Table

Included Studies

The number of studies and publications do not always correspond (e.g., a publication may include several studies, or one study may be explained in several publications).

Effectiveness Review

Auchincloss AH, Michael YL, Kuder JF, Shi J, Khan S, et al. Changes in physical activity after building a greenway in a disadvantaged urban community: a natural experiment. Preventive Medicine Reports 2019;15:100941.

Clark S, Bungum T, Shan G, Meacham M, Coker L. The effect of a trail use intervention on urban trail us in Southern Nevada. Preventive Medicine 2014;S17-20.

Cohen DA, Golinelli D, Williamson S, Sehgal A, Marsh T, et al. Effects of park improvements on park use and physical activity-policy and programming implications. American Journal of Preventive Medicine 2009;37(6):475-80.

Cohen DA, Han B, Derose KP, Williamson S, Marsh T, et al. Physical activity in parks, a randomized controlled trial using community engagement. American Journal of Preventive Medicine 2013;45(5):590-97.

Cohen DA, Han B, Isacoff J, Shulaker B, Williamson S. Renovations of neighborhood parks: long-term outcomes on physical activity. Journal of Epidemiology and Community Health 2019;73:214-18.

Cranney L, Phongsavan P, Kariuki M, Stride V, Scott A, et al. Impact of an outdoor gym on park users’ physical activity: a natural experiment. Health & Place 2016;37:26-34.

Cummins S, Clark C, Lewis D, Smith N, Thompson C, et al. The effects of the London 2012 Olympics and related urban regeneration on physical and mental health: the ORiEL mixed-methods evaluation of a natural experiment. Public Health Research 2018;6(12).

Droomers M, Jongeneel-Grimen B, Kramer D, de Vries Sjer, Kremers S, et al. The impact of intervening in green space in Dutch deprived neighbourhoods on physical activity and general health: results from the quasi-experimental URBAN40 study. Journal of Epidemiology and Community Health 2016;70:147-54.

Evenson KR, Herring AH, Huston SL. Evaluating change in physical activity with the building of a multi-use trail. American Journal of Preventive Medicine 2005;28(2S2):177-85.

Fitzhugh EC, Bassett Jr DR, Evans MF. Urban trails and physical activity: a natural experiment. American Journal of Preventive Medicine 2010;39(3):259-62.

Frank LD, Hong A, Ngo VD. Causal Evaluation of urban greenway retrofit: a longitudinal study on physical activity and sedentary behavior. Preventive Medicine 2019;123;109-16.

Goodman A, Sahlqvist S, Ogilvie D. New walking and cycling routes and increased physical activity: one and 2-year findings from the UK iConnect Study. American Journal of Public Health 2014;104(9):e38-46.

Grunseit A, Crane M, Klarenaar P, Noyes J, Merom D. Closing the loop: short term impacts on physical activity of the completion of a loop trail in Sydney, Australia. International Journal of Behavioral Nutrition and Physical Activity 2019;16(1):1-2.

Gustat J, Rice J, Parker KM, Becker AB, Farley TA. Effect of changes to the neighborhood built environment on physical activity in a low-income African American neighborhood. Preventing Chronic Disease 2012;9:e57.

Harding MC, Bott QD, Jonas CE. The M laekahana Path: an ecological model-based intervention for increasing walking and biking in rural Hawai’i. Journal of Physical Activity and Health 2017;14(12):965-67.

King DK, Litt J, Hale J, Burniece KM, Ross C. ‘The park a tree built’: evaluating how a park development project impacted where people play. Urban Forestry & Urban Greening 2015;14(2):293-9.

New South Wales Department of Health. Walk It: Active Local Parks. The effect of park modifications and promotion on physical activity participation: summary report. Sydney, Australia: New South Wales Department of Health; 2002

Schultz CL, Stanis SA, Sayers SP, Thombs LA, Thomas IM. A longitudinal examination of improved access on park use and physical activity in a low-income and majority African American neighborhood park. Preventive Medicine 2017;95:S95-100.

Slater S, Pugach O, Lin W, Bontu A. If you build it will they come? Does involving community groups in playground renovations affect park utilization and physical activity? Environment and Behavior 2016;48(1):246-65.

Tester J, Baker R. Making the playfields even: evaluating the impact of an environmental intervention on park use and physical activity. Preventive Medicine 2009;48(4):316-20.

Additional Materials

Implementation Resources

Active Parks! Implementation Guide: Increasing Physical Activity Through Parks, Trails and Greenways
Developed by the National Recreation and Park Association and CDC’s Division of Nutrition, Physical Activity, and Obesity

Rural Health Information Hub, Transportation Toolkit
This toolkit compiles information, resources, and best practices to support development and implementation of transportation programs in rural communities. Modules include program models, implementation and evaluation resources, and funding and dissemination strategies.

Publication

Serrano N, Realmuto L, Graff KA, et al. Healthy community design, anti-displacement, and equity strategies in the USA: a scoping review. J Urban Health (2022).

Search Strategies

Effectiveness Review

The CPSTF recommendation is based on a systematic review of 38 studies (published through July 2020). The review combined 26 studies of park, trail, or greenway interventions identified from a published systematic review (Hunter et al. 2019; search period through August 2016) with 12 studies identified in an updated search that used the same search terms (search period August 2016 to July 2020).

Hunter et al. (2019) included 38 studies in their review. The Community Guide review team assessed each study based on community guide methods and identified 26 eligible studies for this review. The Community Guide updated search for evidence used a search strategy adapted from Hunter et al. 2019.

Databases searched for this review included Medline, PsycINFO, CAB Abstracts, Scopus, Cochrane, Greenfiles, and Agricultural & Environmental Science Dissertations Environmental Science Collection.

Medline

1 Environment Design/

2 Urban Health/

3 Parks, Recreational/

4 Forestry/

5 (urban adj green adj space).ti,ab.

6 green*space.ti,ab.

7 (open adj space).ti,ab.

8 (public adj space).ti,ab.

9 (public adj open adj space).ti,ab.

10 (park not parkin*).ti,ab.

11 (city adj park).ti,ab.

12 (public adj park).ti,ab.

13 (urban adj park).ti,ab.

14 (municipal adj park).ti,ab.

15 (greenway or urban greenway).ti,ab.

16 (urban adj regen*).ti,ab.

17 (trail* or (urban adj trail*)).ti,ab.

18 (urban adj forestry).ti,ab.

19 water sensitive urban design.ti,ab.

20 WSUD.ti,ab.

21 sustainable urban drainage system*.ti,ab.

22 bio?retention basin*.ti,ab.

23 green roof*.ti,ab.

24 roof garden.ti,ab.

25 living roof*.ti,ab.

26 green wall*.ti,ab.

27 living wall*.ti,ab.

28 vertical garden*.ti,ab.

29 street tree*.ti,ab.

30 green corridor*.ti,ab.

31 green screen*.ti,ab.

32 urban green*.ti,ab.

33 urban conservation.ti,ab.

34 urban naturalization.ti,ab.

35 urban rehabilitation.ti,ab.

36 urban agriculture.ti,ab.

37 or/1-36

38 intervention stud*.mp.

39 randomised control* trial.mp.

40 randomized control* trial.mp.

41 comparative stud*.mp.

42 control group.mp.

43 (randomised or randomized or randomly or groups).mp.

44 quasi*experiment*.mp.

45 natural experiment*.mp.

46 (pre test or pretest or pre intervention or post intervention or post test or posttest).mp.

47 (intervention or interventional or process or program*).mp.

48 (evaluat* or intervention or interventional or treatment).mp.

49 case stud*.mp.

50 retrofit*.mp.

51 or/38-50

52 37 and 51

53 52 not (animals not humans).sh.

54 limit 53 to dt=20200201-20200731

55 limit 54 to english language

56 limit 55 to abstracts

PsycINFO

1 (Environment* adj design).ti,ab.

2 (urban adj health).ti,ab.

3 Parks, Recreational/

4 (urban adj green adj space).ti,ab.

5 green*space.ti,ab. 49

6 (open adj space).ti,ab. 447

7 (public adj space).ti,ab. 784

8 (public adj open adj space).ti,ab.

9 (park not parkin*).ti,ab.

10 (park not parkin*).ti,ab.

11 (city adj park).ti,ab.

12 (public adj park).ti,ab.

13 (urban adj park).ti,ab.

14 (municipal adj park).ti,ab.

15 (greenway or urban greenway).ti,ab.

16 (urban adj regen*).ti,ab.

17 (trail* or (urban adj trail*)).ti,ab.

18 (urban adj5 forestry).ti,ab.

19 (green adj5 roof*).ti,ab.

20 (roof adj5 garden).ti,ab.

21 (living adj5 roof*).ti,ab.

22 green wall*.ti,ab.

23 (living adj5 wall*).ti,ab.

24 street tree*.ti,ab.

25 green corridor*.ti,ab.

26 green screen*.ti,ab.

27 urban green*.ti,ab.

28 urban conservation.ti,ab.

29 urban rehabilitation.ti,ab.

30 urban agriculture.ti,ab.

31 or/1-30

32 intervention stud*.mp.

33 randomised control* trial.mp.

34 randomized control* trial.mp.

35 comparative stud*.mp.

36 control group.mp.

37 (randomised or randomized or randomly or groups).mp.

38 quasi*experiment*.mp.

39 natural experiment*.mp.

40 (pre test or pretest or pre intervention or post intervention or post test or posttest).mp.

41 (intervention or interventional or process or program*).mp.

42 (evaluat* or intervention or interventional or treatment).mp.

43 case stud*.mp.

44 retrofit*.mp.

45 or/32-44

46 31 and 45

47 exp Animals/ not humans.sh.

48 46 not 47

49 limit 48 to up=20200201-20200731

50 limit 49 to (english language and abstracts)

CAB Abstracts

1 (Environment adj design).ti,ab.

2 (Urban adj Health).ti,ab.

3 (recreational adj park*).ti,ab.

4 Forestry/

5 (urban adj green adj space).ti,ab.

6 green*space.ti,ab.

7 (open adj space).ti,ab.

8 (public adj space).ti,ab.

9 (public adj open adj space).ti,ab.

10 (park not parkin*).ti,ab.

11 (city adj park).ti,ab.

12 (public adj park).ti,ab.

13 (urban adj park).ti,ab.

14 (municipal adj park).ti,ab.

15 (greenway or urban greenway).ti,ab.

16 (urban adj regen*).ti,ab.

17 (trail* or (urban adj trail*)).ti,ab.

18 (urban adj forestry).ti,ab.

19 water sensitive urban design.ti,ab.

20 WSUD.ti,ab.

21 sustainable urban drainage system*.ti,ab.

22 bio?retention basin*.ti,ab.

23 green roof*.ti,ab.

24 roof garden.ti,ab.

25 living roof*.ti,ab.

26 green wall*.ti,ab.

27 living wall*.ti,ab.

28 vertical garden*.ti,ab.

29 street tree*.ti,ab.

30 green corridor*.ti,ab.

31 green screen*.ti,ab.

32 urban green*.ti,ab.

33 urban conservation.ti,ab.

34 (urban adj5 naturalization).ti,ab.

35 urban rehabilitation.ti,ab.

36 urban agriculture.ti,ab.

37 or/1-36

38 intervention stud*.mp.

39 randomised control* trial.mp.

40 randomized control* trial.mp.

41 comparative stud*.mp.

42 control group.mp.

43 (randomised or randomized or randomly or groups).mp.

44 quasi*experiment*.mp.

45 natural experiment*.mp.

46 (pre test or pretest or pre intervention or post intervention or post test or posttest).mp.

47 (intervention or interventional or process or program*).mp.

48 (evaluat* or intervention or interventional or treatment).mp.

49 case stud*.mp.

50 retrofit*.mp.

51 or/38-50

52 37 and 51

53 52 not (animals not humans).sh.

54 (202002* or 202003* or 202004* or 202005* or 202006* or 202007*).ud.

55 53 and 54 762

56 limit 55 to (abstracts and english language)

57 from 56 keep 1-617 617

Scopus

( TITLE-ABS ( “environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR ( bio W/1 retention AND basin ) OR “green roof” OR “roof garden” OR “living roof” OR “green wall” OR “living wall” OR “vertical garden” OR “street tree” OR “green corridor” OR “green screen” OR “urban green” OR “urban conservation” OR “urban naturalization” OR “urban rehabilitation” OR “urban agriculture” ) ) AND ( TITLE-ABS-KEY ( “intervention stud*” OR “comparative stud*” OR “case stud*” OR ( clinic* W/1 trial* ) OR ( randomi* W/1 control* ) OR ( randomi* W/2 trial* ) OR ( random* W/1 assign* ) OR ( random* W/1 allocat* ) OR ( control* W/1 clinic* ) OR ( control* W/1 trial ) OR placebo* OR ( quantitat* W/1 stud* ) OR ( control* W/1 stud* ) OR ( randomi* W/1 stud* ) OR ( singl* W/1 blind* ) OR ( singl* W/1 mask* ) OR ( doubl* W/1 blind* ) OR ( doubl* W/1 mask* ) OR ( tripl* W/1 blind* ) OR ( tripl* W/1 mask* ) OR ( trebl* W/1 blind* ) OR ( trebl* W/1 mask* ) ) AND NOT ( SRCTYPE ( b ) OR SRCTYPE ( k ) OR DOCTYPE ( ab ) OR DOCTYPE ( bk ) OR DOCTYPE ( ch ) OR DOCTYPE ( bz ) OR DOCTYPE ( cr ) OR DOCTYPE ( ed ) OR DOCTYPE ( er ) OR DOCTYPE ( le ) OR DOCTYPE ( no ) OR DOCTYPE ( pr ) OR DOCTYPE ( rp ) OR DOCTYPE ( re ) OR DOCTYPE ( sh ) ) ) AND NOT INDEX ( medline ) AND ( LIMIT-TO ( PUBYEAR,2020) ) AND ( LIMIT-TO ( LANGUAGE,”English” ) )

Cochrane

#1 (“urban green space”):ti,ab,kw (Word variations have been searched)

#2 (“green*space”):ti,ab,kw (Word variations have been searched)

#3 (“open space”):ti,ab,kw (Word variations have been searched)

#4 (“public space”):ti,ab,kw (Word variations have been searched)

#5 (Park NOT parking):ti,ab,kw (Word variations have been searched)

#6 (“city park”):ti,ab,kw (Word variations have been searched)

#7 (“public park”):ti,ab,kw (Word variations have been searched)

#8 (“urban park”):ti,ab,kw (Word variations have been searched)

#9 (“municipal park”):ti,ab,kw (Word variations have been searched)

#10 (greenway or “urban greenway”):ti,ab,kw (Word variations have been searched)

#11 urban NEXT/5 regen*

#12 (trail):ti,ab,kw (Word variations have been searched)

#13 (“urban forestry”):ti,ab,kw

#14 (“green roof”):ti,ab,kw (Word variations have been searched)

#15 (“urban green*”):ti,ab,kw (Word variations have been searched)

#16 (“urban naturalization”):ti,ab,kw (Word variations have been searched)

#17 “urban rehabilitation” ):ti,ab,kw (Word variations have been searched)

#18 #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17 with Cochrane Library publication date Between Feb 2020 and Aug 2020

GreenFILES (Ebsco)

S1 TI ( “environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR “green roof” OR “roof garden” OR “living roof” OR “green wall” OR “living wall” OR “vertical garden” OR “street tree” OR “green corridor” OR “green screen” OR “urban green” OR “urban conservation” OR “urban naturalization” OR “urban rehabilitation” OR “urban agriculture” OR “bio retention basin”) OR AB ( “environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR “green roof” OR “roof garden” OR “living roof” OR “green wall” OR “living wall” OR “vertical garden” OR “street tree” OR “green corridor” OR “green screen” OR “urban green” OR “urban conservation” OR “urban naturalization” OR “urban rehabilitation” OR “urban agriculture” “bio retention basin”)

S2 “intervention studies”

S3 “randomized control* trials” or rtc or “randomised control* trials”

S4 comparative stud*

S5 control group

S6 randomised or randomized or randomly or groups

S7 “quasi* experiment*”

S8 “natural experiment*”

S9 (“pre test” OR pretest PR “pre intervention” OR “post intervention” OR “post test” OR posttest)

S10 (intervention OR inteventional OR process OR programs*)

S11 (evaluat* OR intervention OR interventional OR treatment)

12 “case stud*”

S13 retrofit*

S14 S2 OR S3 OR S4 OR S5 OR S6 OR S7 OR S8 OR S9 OR S10 OR S11 OR S12 OR S13

S15 S1 AND S14

S16 S1 AND S14 Limiters – Scholarly (Peer Reviewed) Journals; Publication Date: 20200201-20200731

Agricultural & Environmental Science Dissertations
Environmental Science Collection

(((((ti((“environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR “green roof” OR “roof garden” OR “living roof” OR “green wall” OR “living wall” OR “vertical garden” OR “street tree” OR “green corridor” OR “green screen” OR “urban green” OR “urban conservation” OR “urban naturalization” OR “urban rehabilitation” OR “urban agriculture” OR “bio retention basin”)) OR ab((“environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR “green roof” OR “roof garden” OR “living roof” OR “green wall” OR “living wall” OR “vertical garden” OR “street tree” OR “green corridor” OR “green screen” OR “urban green” OR “urban conservation” OR “urban naturalization” OR “urban rehabilitation” OR “urban agriculture” OR “bio retention basin”))) AND peer(yes)) AND PEER(yes)) AND ((ti(“intervention studies”) OR ab(“intervention studies”)) OR (ti(“randomized control* trials” OR rtc OR “randomised control* trials”) OR ab(“randomized control* trials” OR rtc OR “randomised control* trials”)) OR (ti(“comparative stud*”) OR ab(“comparative stud*”)) OR (ti(“control group”) OR ab(“control group”)) OR (ti(randomised OR randomized OR randomly OR groups) OR ab(randomised OR randomized OR randomly OR groups)) OR (ti(“quasi* experiment*”) OR ab(“quasi* experiment*”)) OR (ab(“natural experiment*”) OR ti(“natural experiment*”)) OR (ti((“pre test” OR pretest PR “pre intervention” OR “post intervention” OR “post test” OR posttest)) OR ab((“pre test” OR pretest PR “pre intervention” OR “post intervention” OR “post test” OR posttest))) OR (ti((intervention OR interventional OR process OR programs*)) OR ab((intervention OR interventional OR process OR programs*))) OR (ti((evaluat* OR intervention OR interventional OR treatment)) OR ab((evaluat* OR intervention OR interventional OR treatment))) OR (ti(“case stud*”) OR ab(“case stud*”)) OR (ti(retrofit*) OR ab(retrofit*)))) NOT (stype.exact(“Books”) AND la.exact(“ENG”) AND pd(20160801-20200731) AND PEER(yes)))

Review References

Cole H, Triguero-Mas M, Connolly T, Anguelovski I. Determining the health benefits of green space: Does gentrification matter? Health & Place 2019; 57:1-11.

National Recreation and Park Association. Creating equity-based system master plans. Ashburn (VA): 2020. Accessed 12/3/21. Available from URL: www.nrpa.org/publications-research/best-practice-resources/creating-equity-based-system-master-plans/

Healthy People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Social determinants of health. Rockville (MD): 2020. Accessed 11/18/21. Available from URL: https://health.gov/healthypeople/objectives-and-data/social-determinants-health

Hunter RF, Cleland C., Cleary, A., Droomers, M., Wheeler, B.W., et al. Environmental, health, wellbeing, social and equity effects of urban green space interventions: a meta-narrative evidence synthesis. Environment International 2019;130:104923.

Trust for Public Land. Toolkit for health, arts, parks, and equity. 2020. Accessed 12/3/21. Available from URL: www.tpl.org/the-toolkit-for-health-arts-parks-and-equity

Considerations for Implementation

The following considerations for implementation are drawn from studies included in the existing evidence review, the broader literature, and expert opinion.

Parks, trails, and greenways are modifiable social determinants of health (Healthy People 2030). Studies and implementation guidance (generally focused on parks) 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 (Creating Equity-Based System Master Plans 2021). To achieve this, health equity principles can be used to guide park priorities and investments in ways that involve and sustainably benefit communities (Cole et al. 2019).
  • Equity-based park guidelines emphasize cross-sector partnerships, community engagement, and strategic data collection and analysis (Creating Equity-based System Master Plans 2020; Toolkit for Equity 2020.

Implementation guidance incorporating equity considerations is available from several organizations:

The National Recreation and Park Association advocates for parks and recreation throughout communities 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 across the country. They provide reports and action guides for local government leaders and organizations as well as information about their Community Action model.

The Prevention Institute has developed a toolkit for community-based organizations, including a park equity toolkit tip sheet and a webinar series.

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: