Elsevier

Social Science & Medicine

Volume 124, January 2015, Pages 246-256
Social Science & Medicine

Review
The impact of interventions to promote physical activity in urban green space: A systematic review and recommendations for future research

https://doi.org/10.1016/j.socscimed.2014.11.051Get rights and content

Highlights

  • Urban green space can influence community and population physical activity levels.

  • Some evidence to support built environment only interventions for physical activity.

  • More promising evidence to support activity programs or combined interventions.

  • Studies require longer term follow-up and consideration of the social environment.

  • These findings have significant public health policy and practice implications.

Abstract

Evidence is mounting on the association between the built environment and physical activity (PA) with a call for intervention research. A broader approach which recognizes the role of supportive environments that can make healthy choices easier is required. A systematic review was undertaken to assess the effectiveness of interventions to encourage PA in urban green space. Five databases were searched independently by two reviewers using search terms relating to ‘physical activity’, ‘urban green space’ and ‘intervention’ in July 2014. Eligibility criteria included: (i) intervention to encourage PA in urban green space which involved either a physical change to the urban green space or a PA intervention to promote use of urban green space or a combination of both; and (ii) primary outcome of PA. Of the 2405 studies identified, 12 were included. There was some evidence (4/9 studies showed positive effect) to support built environment only interventions for encouraging use and increasing PA in urban green space. There was more promising evidence (3/3 studies showed positive effect) to support PAprograms or PA programs combined with a physical change to the built environment, for increasing urban green space use and PAof users. Recommendations for future research include the need for longer term follow-up post-intervention, adequate control groups, sufficiently powered studies, and consideration of the social environment, which was identified as a significantly under-utilized resource in this area. Interventions that involve the use of PA programs combined with a physical change to the built environment are likely to have a positive effect on PA. Robust evaluations of such interventions are urgently required. The findings provide a platform to inform the design, implementation and evaluation of future urban green space and PAintervention research.

Introduction

Prevalence of physical inactivity and its associated health conditions are rising, and the inexorable slide to a more inactive lifestyle has worrying implications for future levels of obesity, morbidity and mortality (Lee et al., 2012). A broader approach which recognizes the role of supportive environments that can make healthy choices easier is required. However, physical activity (PA) is a complex behavior that is often discouraged in modern built and social environments (Khan et al., 2011). Considerable evidence is mounting on the association between PA and the built environment in which an individual lives (O Ferdinand et al., 2012). Accordingly, the potential of the built environment as a determinant of PA, and its ability to influence community and population levels of PA is becoming more widely recognized (Department of Health, 2007, World Health Organization, 2010).

In particular, urban green space (UGS) has an important contribution to make to public health with potential physical, psychological, social, economic and environmental benefits (Bedimo-Rung et al., 2005, Bowler et al., 2010, Lee and Maheswaran, 2010, Lachowycz and Jones, 2011). Urban green space is defined as all publicly owned and publicly accessible open space with a high degree of cover by vegetation, e.g., parks, woodlands, nature areas, and other green space within the city boundary area (Schipperijn et al., 2013). Cross-sectional evidence highlights the association between UGS and PA. The availability and accessibility of UGS, particularly across the socio-economic spectrum, offers the opportunity for recreation and active travel for little or no cost to the individual. Physical activity has been shown to have positive associations with proximity, access, size and quality of UGS (Giles-Corti et al., 2005, Mowen et al., 2007, Kaczynski et al., 2011). Attributes of UGS that might stimulate and encourage PA include walking/cycling paths, wooded areas, open spaces, water features, lighting, pleasant views, bike racks, parking lots, and playgrounds (Schipperijn et al., 2013). However, to date much of the research in this area has been observational and shows that many UGS are under-utilized (Floyd et al., 2008, Floyd et al., 2011, Cohen et al., 2010, Kaczynski et al., 2011).

Interventions specifically targeting use of UGS may assist with increasing PA behavior change at the community and population level. Urban green spaces receive significant investment for modifications and programming, particularly from local authorities. Examples include improving access to UGS, improving walking/cycle paths, and playground/park facilities in UGS. Interventions to specifically promote and encourage use of UGS or specific features of UGS include awareness, marketing and promotional campaigns, and PA programs in UGS. There is a need to identify if such investments are effective in increasing use of UGS and PA of UGS users, and subsequently determine how to make best use of UGS for public health. As with other aspects of built environment research, there has been a call for evidence of the effectiveness of environmental interventions to initiate and help maintain PA behavior change. Therefore, the aim of this study was to undertake a systematic review to assess the effectiveness of interventions to promote PA in UGS, including the development of new UGS.

Section snippets

Search strategy

Five electronic databases (Medline, EMBASE, CINAHL, Sport DISCUS and PubMed) were searched for articles published up to July 2014, and reference lists of included studies were hand searched for further relevant papers. Keywords relating to ‘physical activity’, ‘urban green space’ and ‘intervention’ were searched (see Appendix I).

Eligibility criteria

Studies were included if they met the following criteria:

  • (i)

    intervention to promote/encourage PA in UGS

  • (ii)

    primary outcome measure of PA levels, including subjective and

Results

Appendix II shows the results of the literature search. Briefly, 2405 studies were initially identified, 64 full-text articles screened, and 12 studies included in the review.

Discussion

In summary, there was some evidence to support the use of built environment only interventions for encouraging use and increasing PA in UGS. However, more promising evidence existed for the use of PA programs combined with a physical change to the built environment. These findings highlight that multifaceted UGS intervention strategies are likely to have a more significant impact on levels of PA than changes to the built environment in isolation. However, these results should be interpreted

Conclusion

Physical inactivity is a major public health concern, with implications for our health, society and economy. The public health dividend of increasing PA in the population is substantial. UGS has the potential to contribute significantly to public health as a setting that encourages participation in PA. Physical activity behavior change at the community and population level might be increased by interventions specifically targeting use of UGS (Cohen et al., 2007). Results from this review show

Acknowledgments

RH is funded by the National Prevention Research Initiative (NPRI) (ID G0802045) and UKCRC Centre of Excellence for Public Health (NI) (ID MR/K023241/1B). HC is supported by a National Health and Medical Research Council (NHMRC)/National Heart Foundation Early Career Fellowship (ID 1036350). JV is supported by a National Health and Medical Research Council Early Career Fellowship (ID 1053426). TAB is supported by a National Heart Foundation of Australia Postdoctoral Fellowship (ID 100161).

The

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