ReviewAssociation of proximity and density of parks and objectively measured physical activity in the United States: A systematic review
Introduction
Over the past fifty years, the United States (US) has witnessed an increase in sedentary activity and a corresponding decrease in physical activity related to transportation, leisure-time and work (Brownson et al., 2005). Physical activity has been linked to improved mental and physical health (Warburton et al., 2006). While the US Centers for Disease Control and Prevention recommends at least 1 h of physical activity per day for children and adolescents, and a minimum of 225 min per week of moderate to vigorous physical activity for adults, most people in the US do not meet this recommendation (CDC., 2014, Tucker et al., 2011).
Research has shown that active transportation (primarily walking and biking) and access to exercise facilities can increase physical activity (Handy et al., 2002, Sallis et al., 1992). The built environment—defined as human-made or modified environment, including transportation, food outlets, and parks—increasingly has been recognized as a determinant of physical activity and population health (Lee and Moudon, 2004, Rao et al., 2007, Srinivasan et al., 2003). In particular, pedestrian-supportive built environment characteristics such as open space, mixed land use and walkability predict increased physical activity (Brownson et al., 2009, Durand et al., 2011, Papas et al., 2007, Sallis et al., 1998). Commercial facilities such as gyms may also promote physical activity, at least among persons with memberships (Kaufman et al., 2014). Parks are common locations for recreational physical activity and are accessible to a wider population (Giles-Corti et al., 2005, Godbey et al., 2005, Lee and Moudon, 2004). However, research on the association of parks and physical activity has employed a mixture of self-reported and objective measurement approaches that may contribute to inconsistency in study findings. While previous research has reported mixed findings concerning the association of parks and physical activity, we focused more specifically on research using objectively measured physical activity through devices such as accelerometers. We propose that such device-based physical activity measurement is the best single measurement approach at this time for addressing our research question: does the current research literature support investments in local parks as a strategy to increase total physical activity of local residents?
Previous systematic reviews have investigated the association of urban planning, recreational facilities, traffic, safety and parks with physical activity (Durand et al., 2011, Ferdinand et al., 2012, Kaczynski et al., 2008). One of these reviews suggested that the built environment was more likely to be associated with self-reported than objectively-measured physical activity (Ferdinand et al., 2012). In a review of the international research literature, fewer than one-quarter of studies (9 out of 41) included objective measures of physical activity, and only 3 of those papers found a positive association between activity and green space (Lachowycz and Jones, 2011). Despite the recent growth in research using accelerometers, pedometers and other portable devices, to our knowledge, no review has focused only on studies with objectively measured physical activity and measures of access to parks in the US.
This review assesses evidence relevant to whether investments in creating, maintaining or improving parks would increase total objectively measured physical activity among area residents. It aims to identify limitations in current measurement and reporting practices for built environment characteristics and physical activity and to offer recommendations ways to standardize reporting and improve measurement strategies, providing a stronger evidence base for policy.
Section snippets
Information sources and eligibility criteria
A systematic search of the published literature was conducted in PubMed, PsycInfo, TRIS, ALR Literature Database, and Web of Science, using similar methods as described previously (Lovasi et al., 2009). We searched PsycInfo and the ALR database for dissertations, in order to include gray literature. Previously published reviews and references from included studies were also screened.
Studies were eligible for this review if: 1) conducted in the United States with a sample size of 100 individuals
Search and study selection
The database search resulted in 15,739 abstracts of which 10,949 were unique (Fig. 1). These abstracts were then screened for inclusion. In addition, 133 articles from the Active Living Research Database and 187 systematic or narrative reviews were screened for potential additional references. Ultimately, 801 full text articles were reviewed for eligibility and 320 were abstracted into a database of US-based studies linking the built environment to physical activity or adiposity. Among these,
Discussion
In this review of the past twenty years of US studies, we found no consistent pattern of results relating park exposure to objectively measured physical activity. Five studies found a statistically significant positive association between access to parks and physical activity; nine studies found no association; and six studies had mixed findings. Our results add to previous reviews that included objective and self-reported physical activity and called for consistency in measures of green space
Acknowledgments
The authors would like to acknowledge financial support from Robert Wood Johnson Foundation Active Living Research program (grant #68507).
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