Physical Activity Interventions
Environmental and policy interventions to promote physical activitya

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Abstract

Background:

Because most adults in industrialized countries do not meet physical activity guidelines, population-wide interventions are needed. Environmental and policy interventions are based on ecological models of behavior and have the potential to influence entire populations. Ecological models are particularly applicable to physical activity because the behavior must be done in specific physical settings. Cross-sectional data indicate that environmental and policy variables are associated with physical activity behaviors of young people and adults.

Method: Seven published evaluations of environmental and policy interventions to increase physical activity were reviewed.

Results: Two studies showed that placing signs encouraging stair use can be effective. Quasi-experimental evaluations provided limited evidence that broad environmental changes can be effective. Large-scale policy interventions are currently being conducted in several countries.

Proposed Model: A model describing the development of policy and environmental interventions is proposed, in the hope of stimulating more research in this area. Advocacy or planning groups identify and work with agencies that control policies and environments that can be altered to increase physical activity. Educational and policy/environmental interventions are seen as complementary.

Conclusion: Lack of conceptual models and the inherent difficulties of evaluation have hampered research on environmental and policy interventions. Further research is needed, and practitioners and researchers should work together to evaluate programs.

Section snippets

Ecological models as a basis for environmental and policy interventions

Ecological and social-ecological models of human behavior have evolved over decades in the fields of sociology, psychology, education, and public health,8 and their relevance to health behaviors is widely recognized.9, 10, 11, 12 In the present paper, “ecological” refers to people’s transactions with their physical and sociocultural environments.13 “Policy” refers to legislative, regulatory, or policy-making actions that have the potential to affect physical activity. Legislative and regulatory

Environmental and policy targets for physical activity interventions

Because there are few published studies of environmental and policy interventions to promote physical activity, it may be useful to conceptualize specific promising approaches, with the goal of stimulating empirical studies. Using an ecological framework specific to physical activity,17 Table 1 lists examples of interventions in four categories: (1) natural environment, (2) constructed environment, (3) policies related to incentives, and (4) policies related to resources and infrastructure.

A political dimension of environmental and policy interventions

Implementing environmental and policy interventions requires political change, which means the public must support the interventions. Surveys have documented substantial public support for policy changes to control alcohol, tobacco, and high-fat food consumption,18, 19 and at least one study has indicated support for policies to increase physical activity.20 Additional surveys to gauge public opinion for environmental and policy interventions to change physical activity may be important tools

Environmental variables are associated with physical activity

Findings from numerous cross-sectional studies support the ecological hypothesis that environmental variables and physical activity are correlated. Such findings help justify the conduct of more rigorous controlled intervention studies and can suggest specific environmental variables to be targeted in interventions.

The strongest evidence comes from observational studies of preschool children. In three studies, children were found to be much more active outdoors.21, 22, 23 In all three studies,

Studies of environmental and policy interventions

Seven published studies of environmental and policy interventions are summarized in Table 2 These studies were found in the authors’ files and through personal contacts; computerized literature searches using multiple keywords revealed no additional articles. Studies of environmental and policy interventions in schools,48 worksites,49 and through the mass media50 were not reviewed, as they are covered elsewhere in this issue. But to summarize briefly, these areas contain relatively few

A proposed model for developing and implementing environmental and policy interventions

Because few studies have evaluated environmental and policy interventions, a conceptual model of how these interventions could be implemented is proposed. In Table 1 some specific ideas for intervention targets were offered, but because mounting these interventions is complex, some guidance may be helpful. In Figure 1 a model for conceptualizing the steps that may be required to implement macro-level interventions is offered. The model has been adapted from the work of the New South Wales

Ongoing efforts to develop and implement environmental and policy interventions

Four ongoing initiatives, three American and one Australian, serve as good examples of ongoing efforts to develop and implement environmental and policy interventions.

Experimental designs

The difficulties involved in evaluating environmental and policy interventions in controlled experimental trials will continue to constrain the development of this field. It is inherently difficult to evaluate macrolevel interventions, as the community heart disease prevention studies have shown.65 However, the COMMIT trial of community-wide smoking control in the United States shows it is possible to randomize large numbers of communities to experimental conditions.66 These studies are

Summary

Both the theory and research directly related to environmental and policy interventions to promote physical activity are in their early stages of development. There appears to be growing interest in the potential of these interventions to improve public health, but the challenges of designing interventions, implementing them, formulating research design, and measuring change all slow the accumulation of evidence on their effectiveness. The potential for these interventions to affect large

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      Schools are widely recognized as critical settings for daily PA because they provide access, structure, and systems to support healthy behaviors and health behavior change (Perry et al., 1992). Schools are the only setting that reach nearly all children (Pate et al., 2006; Sallis et al., 1998, 2003; Story, 1999), with most children spending almost half of their waking hours at school (about 36 weeks/year) for 12 years (Lounsbery et al., 2013a). In elementary schools, physical education (PE), recess, classroom PA breaks, and other before- and after school programs contribute substantially to MVPA accrual (Lounsbery et al., 2013b; Payne and Morrow, 2009; Sallis et al., 2012; Story et al., 2009); however, recess may be the most significant source of PA at school as movement during recess provides up to 44 % of all school-based PA (Erwin et al., 2012) and counters sedentary time (Guinhouya et al., 2009; Ridgers et al., 2005).

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    a

    This work was prepared for the CIAR Conference on Physical Activity Promotion: An ACSM Specialty Conference.

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