It has been well-established that physical activity and/or exercise can help to reduce the risk of chronic diseases such as obesity, diabetes, cancer and cardiovascular disease.  

To reap these benefits, we only need to accumulate 150 minutes per week of physical activity1. That means that you can be physically active for as little as 10 minutes at a time to accumulate 30 minutes in a day for five days, or be active for about 20 minutes per day for seven days. Even though accumulating physical activity in small increments is just as good for our health as being physically active in one longer bout, many people still find it difficult to incorporate physical activity and/or exercise into their lives.  

Despite public health efforts to encourage more physical activity among the population, the Centers for Disease Control and Prevention (CDC) state that only about 28% of individuals exercise on a regular basis1. However, if the environment was such that it allowed individuals to be more physically active more naturally, perhaps more individuals would meet physical activity recommendations.

Research on the affects of built environment 

The built environment has been shown to have an effect on physical activity. For example, cities that have bike lanes, accessible parks, sidewalks and walking trails typically have higher levels of physical activity among their citizens. Conversely, cities that lack these features, tend to have lower physical activity levels among their residents. Other variables also come into play, including resources to make changes to the built environment, safety, lighting and the weather.  

Some researchers wanted to identify which changes to the built environment increase physical activity in residents at the local level, taking into account cost and socioeconomic status. It was found that enhancements to the infrastructure of a city tended to benefit those of lower socioeconomic status. It appears that improvements in walkability, enhancing parks and playgrounds, and having sufficient active transport within a city will increase physical activity in both children and adults2,3. This is encouraging, because increasing physical activity among all ages is important for the health of our population. 

Although increasing physical activity, and subsequently improving overall health among all ages is important, some researchers have studied whether changes in the built environment specifically increased physical activity levels in older adults (greater than 65 years of age). They found that the factors that led to increased physical activity in older adults included: walkability, how well streets connect, mixed land use, access to facilities, services available, street lighting, having more accessible green space and crime- and traffic-related safety4. It is important that cities take into account all of these variables when they are making decisions about improving infrastructure. The health of their citizens needs to be at the forefront in their decision making. In doing so, not only will this decrease healthcare costs, but it will attract more people to want to visit or reside in that city, helping the economy.  

Even if cities have good built environment infrastructure, it may not lead to increases in physical activity for all. For example, in neighborhoods of low-income it has been reported that when women went to parks, it was largely for the purpose of taking their children to play, whereas men typically went to parks for their own physical activity. Furthermore, it was found that older adults did not get to parks as much as they would like because many of the facilities for them were inadequate5.  

Adding green (grass) and blue (water) spaces can also lead to greater physical activity. Some researchers found that putting grass on hard spaces in school yards led to increased physical activity and improved social well-being among children in elementary school6. 

The built environment is extremely vital for both physical activity and social interactions, leading to improved physical and mental health. When making decisions for city infrastructure renovations, policy makers should empower their citizens to help make informed decisions based on age, sex and socioeconomic status. Even if parks have meeting places where people may only go to sit and talk with their friends or play chess, this can still result in more physical activity than if people were to remain at home. If citizens are empowered to help make decisions for their cities and towns, they are more likely to use the facilities, leading to healthier lives. 

Author:  Stella L. Volpe, Ph.D., RDN, ACSM-CEP, FACSM 

Chair, American Fitness Index 

President-elect, American College of Sports Medicine

Originally published on October 30, 2023

References 

1. Centers for Disease Control and Prevention. https://www.cdc.gov/physicalactivity/basics/adults/index.htm 
2. Smith M, Hosking J, Woodward A, et al. Systematic literature review of built environment effects on physical activity and active transport – an update and new findings on health equity. Int J Behav Nutr Phys Act. 2017;14(1):158.doi: 10.1186/s12966-017-0613-9. 
3. Laddu D, Paluch AE, LaMonte MJ. The role of the built environment in promoting movement and physical activity across the lifespan: Implications for public health. Prog Cardiovasc Dis. 2021:64:33-40. doi: 10.1016/j.pcad.2020.12.009. 
4. Bonaccorsi G, Manzi F, Del Riccio M, et al. Impact of the built environment and the neighborhood in promoting the physical activity and the healthy aging in older people: An umbrella review. Int J Environ Res Public Health. 2020;17(17):6127. doi: 10.3390/ijerph17176127. 
5. Cohen DA, Han B, Park S, et al. Park use and park-based physical activity in low-income neighborhoods. J Aging Phys Act. 2019;27(3):334-342. doi: 10.1123/japa.2018-0032.  
6. Raney MA, Hendry CF, Yee SA. Physical activity and social behaviors of urban children in green playgrounds. Am J Prev Med. 2019;56(4):522-529. doi: 10.1016/j.amepre.2018.11.004.  

I love my local public green spaces. I have two (a town park and a nearby school) within easy walking/biking distance from home. We see friends and acquaintances regularly when at the playground, swimming in the river or attending community events like concerts, fairs or athletic competitions. It is wonderful to connect with your neighbors and really feel part of the community. Public green space is lovely in my rural town, but they are a necessity in urban settings. Urban green spaces have been shown to support healthy behaviors including increased physical activity and social engagement. 

Urban green spaces are public land with vegetation, parks, forests or water features, located within an urban setting. They are typically open spaces to support people gathering for social, leisure and recreational activities, and are critical components in fostering social cohesion and a sense of belonging. Social cohesion refers to the interpersonal dynamics and sense of connection among humans, and higher levels are associated with physical and psychological benefits. Maslow’s Hierarchy of Needs starts with physiological needs (food, water and rest) and safety/security, then the next important need is that of love and belonging. Humans have a need for affiliation; to be part of a team or tribe. From an evolutionary perspective, social bonds have helped humans to survive and thrive. Urban green spaces provide a place for people to gather to build these social connections.  

A “green third place”

To further emphasize this concept, consider that there are several places in our lives where we can connect with others and build relationships. Urban green spaces are ideal “third places”; Ray Oldenburg’s concept of social surroundings for your community life versus your first place (home; personal life) or second place (work life)1. It should be a comfortable, welcoming, and accessible space for social interaction that fosters a sense of belonging. Like Cheers pub in Boston, “Where everybody knows your name.” 

In a third place you are free of obligations, all are of equal social status, newcomers are welcomed, connection is the focus with playful conversation and socializing, and it is a homey, inviting space that is conveniently located. Connections can be through shared leisure interests, activities or hobbies, shared neighborhoods or shared cultures. Third places can be a commercial space like a café, pub, bookstore, barber shops, quilt store; religious places; libraries; shared leisure facilities like gyms or bowling alleys; or outdoor recreation/gathering places such as parks and green spaces (my personal favorite).  

One of the characteristics of a third place is accessibility—ideally being within walking distance of home. One of the key metrics of ACSM’s American Fitness Index rankings is percentage of a population within 10-minute walk to a park. My two closest cities, Boston and New York, tied for highest score (99%) with Arlington, San Francisco and St. Paul. Additionally, that walk should be safe, so the Fitness Index also assesses pedestrian fatalities, Complete Streets policies and bike/walk scores.  Other related community/environment Fitness Index indicators include parks per 10,000 residents, recreation facilities (ball diamonds, basketball hoops, playgrounds, recreational centers, swimming pools and tennis courts), and park expenditure per resident. Perceived pedestrian and leisure facilities (including park density) are key aspects of sense of community belonging2. Having green spaces nearby contributes to the health of the individual and the community while enhancing social cohesion.

See how your city ranks on the above indicators by using our rankings comparison tool. 

Supporting all aspects of health

Neighborhood/built environment and social/community context are key social determinants of health. Simply having more green spaces nearby can help address some of the disparities in health outcomes that especially affect marginalized communities. Access to urban parks has been shown to decrease the negative effects of inadequate housing and emotional stress as well as increase social cohesion for immigrant families3. There are also climate related benefits with more trees improving air quality and decreasing the temperature of urban areas.  

Urban green spaces are multifunctional and multigenerational, supporting a variety of communal activities. I especially like the physical activity opportunities from athletic courts and fields, playgrounds, skateparks/plazas and water features. Skate parks provide recreational space for various wheels including skateboards,  rollerblades, BMX bikes and scooters, and are an alternative to organized sports where kids coach one another. When there is greater social cohesion in a community parents can feel more comfortable allowing kids more freedom knowing that their neighbors will look out for them. Having places for kids to safely gather can contribute to their sense of belonging and decrease feelings of loneliness. Third places are vital for nurturing healthy relationships where you can let your guard down and can feel part of something bigger than yourself.  

Urban parks provide open spaces for communal gatherings, parties, concerts and games like Mah-Jongg or Ultimate Frisbee. Opportunities for synchronous movement like dancing, yoga, Tai Chi or group training can enhance social cohesion by activating the mirror neural network releasing dopamine, creating feelings of pleasure and bonding. Urban green spaces can also provide commercial space for farmers markets or flea markets and agricultural space for urban or community gardens. This can increase the percentage of residents consuming more fruits and vegetables per day (other Fitness Index indicators!). Exposure to nature and green spaces directly contributes to improved physical and psychological health as also discussed in our previous blogs (here, here and here). 

So, find your local “green third place” to really connect to your community and start living your best life. 

Author: Melissa W. Roti, PhD, FACSM

Professor, Director Exercise Science Program

Westfield State University, Westfield, MA

On Twitter: @MelissaRoti 

Originally published on August 31, 2023

References

 1. Oldenburg, Ray (1989). The Great Good Place: Cafes, Coffee Shops, Community Centers, Beauty Parlors, General Stores, Bars, Hangouts, and How They Get You Through the Day. New York: Paragon House. ISBN 978-1-55778-110-9.

2.  Du, Y, Jiang H, Huang Z, & Yang H. (2023) Associations between neighborhood environment and sense of community belonging in urban China: Examining mediating effects of neighborly interactions and community satisfaction. Front Public Health vol 10: 1105473.

3. Hordyk, SR, J Hanley, & E Richard. (2015) “Nature is there; its free”: Urban greenspace and the social determinants of health of immigrant families. Health Place Vol 34:74-82.

Have you ever wandered to a local park after a long day or a long week, taken a deep breath, and felt stress and tension leave your body? You are not alone. Just 20 minutes per day of exposure to natural environments decreases stress and improves cognitive function, blood pressure, mental health, physical activity and sleep. Chronic stress raises blood pressure and heart rate and is linked to anxiety, depression, heart disease and obesity. The ACSM American Fitness Index 2023 annual report found that, on average, 30% of residents in the 100 most populous U.S. cities have high blood pressure and/or obesity and 10% have diabetes. We know that physical activity can help to prevent and/or treat these chronic conditions. Spending time in nature can too! Some of the best treatments are not found in your local pharmacy.  

Most adults in the United States are not meeting the ACSM and CDC recommendations of 150 minutes of light to moderate intensity activity every week with muscle strengthening added in two times per week. The Fitness Index found that only 50.9% of people in the 100 most populous cities were meeting aerobic activity guidelines and only 23.7% were meeting the guidelines for both aerobic and strength activities. Access to nature and green space can decrease sedentary activity, increase physical activity and have a bonus of decreased anxiety and improved cognitive function.  

It is difficult to explain why communing with nature has so many health benefits – is it the fresh air, cool breeze, sights and sounds? Or the increased physical activity that often happens when outdoors? I think it is a little bit of both.  One study compared individual responses to different levels of nature by looking at an individual’s pre and post exposure stress levels after visiting a natural setting, a built urban municipal park and a local fitness facility featuring an indoor track and free weights. Levels of cortisol (stress hormone) decreased the most in the natural environment setting. The stress reduction response appeared to be dose dependent with both the natural environment and urban environment providing visitors a decrease in stress through less demands and worries and increased levels of joy. The indoor track provided decreased demands and worries but no change in joy. Moving is good for you. But moving in a natural or outdoor urban environment is even better. 

In the cities ranked by the American Fitness Index, an average of 71.5% of residents live within a 10-minute walk to a park. Only 38% percent of people in Louisville, Kentucky live within a 10-minute walk to a park and the city also ranks among the worst 10 cities for elevated blood pressure, heart disease, diabetes, asthma and obesity. While the cause of these chronic conditions is multifactorial, all of these Fitness Index indicators can be improved with increased physical activity and access to nature or parks. Arlington, Virginia was named the fittest city in America for the sixth time! In contrast to Louisville, 99% of Arlington residents live within a 10-minute walk to a park. They also had the highest percentage of residents exercising in the last 30 days and the lowest percentage of residents with diabetes.  

Find your nature prescription!  Seven out of 10 people can walk to a park within their city. Active transportation, like walking, biking and running, is also a great way to incorporate physical activity and the outdoors into a busy day. If you need help finding your nearest park or walking/biking trail, check out AllTrails. Thirty percent of people have less access to a park within their city. Encourage your community leaders and city officials to incorporate green spaces, walking trails and recreation opportunities into new and existing developments.  

I challenge you to at least 20 minutes in nature every day while meeting exercise guidelines for long term mental and physical health. 

Author:  Jessie Fudge, M.D., FACSM

Originally published on July 31, 2023

For children, playgrounds offer numerous physical, social and cognitive benefits, including the development of motor skills, social skills, creativity and independence. These structures, defined as a designated play area that contains traditional play equipment linked together by paths, provide rich contexts for children to explore their social and physical environments. As a result, playgrounds offer a unique opportunity for children to spontaneously engage in child-directed play. On the playground, children can explore various age-appropriate movement patterns and preferred activities—allowing them to engage in meaningful and fun physical activity.

Although playgrounds can be found in most neighborhoods (America’s 100 most populous cities average 2.5 playgrounds per 10,000 residents), many were designed to meet the needs and movement patterns of children without disabilities and not necessarily those with different social and physical capabilities. For example, for a child using an assisted walking device (e.g., a cane, walker, wheelchair), a traditionally designed playground may lack accessible entrances onto the equipment, thus hindering their ability to freely move around. On the other hand, playgrounds designed to meet the needs of children with all capabilities provide a motivating and inclusive environment to assist in healthy growth and development. These inclusive spaces can provide a critical opportunity to engage in physical activity. Regular physical activity is important for all children, but it’s important to note that children with disabilities tend to be less physically active than their typically developing peers.

Organizations like the National Center on Health, Physical Activity, and Disabilities and the Canadian Disability Participation Project define inclusion as an opportunity for all children to have the right to: 1) Be respected and appreciated as a part of the community; 2) Participate fully in activities; and 3) Interact with all peers to develop relationships and respect the opinions of others. Inclusive playgrounds are one way to provide equitable access and opportunities for play for all children and offer the opportunity for both children and adults to engage with the environment, enabling participants to have quality play moments.

Laws and standards (e.g., Americans with Disabilities Act Standards for Accessible Design) have been sanctioned to allow access to public structures. Accordingly, the 2010 Standards for Accessible Design, Play Areas require all play areas designed after March 15, 2012, to have at least one accessible route to each play structure. For example, all playgrounds must have ramp accessibility for raised equipment. Although these standards suggest promise for the development of equitable playgrounds, they are highly focused on meeting the needs of children with physical disabilities while failing to consider the needs of children with developmental disabilities. For example, many playgrounds lack a quiet sensory area that may be necessary for a child with a sensory processing disorder. Therefore, an accessible playground does not equate to an inclusive playground.

Numerous recommendations have been put forth to promote inclusive playgrounds to meet the needs of all children. One of the most common strategies is based on the Principles of Universal Design. Universal design is the development of products and environments to meet the needs of all individuals to the greatest extent possible without the need for modifications. An example of this is the presence of sidewalk curb cuts that allow any individual – someone using an assisted walking device, a parent with a stroller, or someone using a shopping cart – the opportunity to cross the street without needing to struggle to maneuver around a curb. Additional resources include those provided by The Canadian Disability Participation Project and Canadian Tire Jumpstart Charities. These organizations recommend 13 evidence-based recommendations to help to make playgrounds more inclusive.

Evidence-based Recommendations for Creating Inclusive Playgrounds:

1. Entry Points: concerned with the perimeter of the playground and the paths to the playground surface.
   1. Ensure that the playground entrances are wide and free of obstacles.
   2. Provide wide, flat, and firm pathways leading to the playground.
   3. Consider enclosing the playground to prevent children from straying.
2. Surfacing and Paths: concerned with the surface on which the play components are installed and the paths between the play structures.
   1. Use flat, uniform surfaces that consist of moderately firm and stable materials.
   2. Provide ramps that have access to and between elevated play components.
3. Features to Foster Inclusive Play: elements account for a variety of needs, abilities and desires.
   1. Provide play equipment that is accessible to all.
   2. Ensure that play equipment provides an appropriate challenge to all.
   3. Reduce overstimulation by spreading out sensory play components throughout the play environment.
   4. Reduce overstimulation by providing spaces for solitary play.
   5. Include components of environment that are designed to stimulate creativity.
   6. Use supplemental aids for spatial orientation, communication and guidance for play.
   7. Provide shaded areas for temperature regulation.
4. Staffing and Supervision: concerned with the staff that supervise and assist on the playground.
   1. Ensure that staff are trained to support the needs of those with disabilities.
5. Design Process: concerned with the stage of design the playground.
   1. Consider involving all parties in the design of the equipment.

Since the strategies above help to create a more inclusive physical environment, fitness professionals should consider the playground as a potential physical activity setting for their clients, including children and families. Fitness professionals can also join families, early interventionists and community members to advocate for the development of inclusive playgrounds in their communities. These efforts will ensure healthy, inclusive spaces for all children to play and develop. Not only can fitness professionals collaborate with other stakeholders (e.g., parents, community organizations, city planners) to promote more inclusive playgrounds, given their passion for and knowledge of the benefits of physical activity in children, they can lead the way.

Authors: Vincenzo Nocera, Ph.D., Sharon E. Taverno-Ross, Ph.D., Michaela Schenkelberg, Ph.D.

Originally published on June 28, 2023

Additional Resources:

Brown, D.M.Y., Ross, T., Leo, J., Buliung, R.N., Shirazipour, C.H., Latimer-Cheung, A.E. and Arbour-Nicitopoulos, K.P. (2021). A Scoping Review of Evidence-Informed Recommendations for Designing Inclusive Playgrounds. Front Rehabilit Sci. 2: 1-13.  

Canadian Disability Participation Project (2023). Blueprint for Building Quality Participation on Playgrounds for Children with Disabilities. University of Toronto, Toronto, ON, Canada.  

National Center for Physical Activity, Health, and Disability (n.d.). Discover Inclusive Playgrounds: A Guide for Playground Users. Available at: https://www.nchpad.org/1616/6650/Discover~Inclusive~Playgrounds  

Ross, T., Arbour-Nicitopoulos, K., Kanics, I.M., and Leo, J. (2022). Creating Inclusive Playgrounds: A Playbook of Considerations and Strategies. Holland Bloorview Kids Rehabilitation Hospital. Available at: www.hollandbloorview.ca/playgroundsplaybook

Gardening goes in and out of fashion over time, but the COVID-19 pandemic ushered in a new, younger wave of gardeners, many of whom grow in one of the more than 29,000 community garden plots located in city parks in the 100 largest U.S. cities. Community gardens have many benefits, including promoting healthy eating and physical activity, improving mental health and building social connections. With its many advantages, you could consider community gardening a “superfood” of activity. 

One of the most obvious benefits of community gardens is that they increase access to healthy foods. In fact, adults who participate in community gardening eat more fruits and vegetables than those who don’t garden. By growing their own produce, gardeners can specifically plant foods that they like to eat as opposed to being restricted  to what’s available in grocery stores. This is especially important in low-income neighborhoods where access to fresh fruits and vegetables may be limited. Food insecurity, or the limited access to nutritionally adequate food, affects an average of 11.5% of residents in the largest 100 US cities. Community gardens are an important tool to seasonally reduce food insecurity concerns up to 90% in impacted communities. 

Community gardens also promote physical activity. Gardening is a whole-body activity that can burn the same number of calories as a traditional workout. Plus you get the added benefit of time spent in nature! Typical gardening tasks like digging, raking, lifting and squatting are excellent at burning calories, strengthening muscles and increasing physical fitness. Depending on the task, gardening can be a low- to moderate-intensity activity that helps meet the ACSM recommendation for 150 minutes of physical activity each week.  

In addition to physical health benefits, community gardens help improve mental health and social connections. Studies have shown that gardening  reduces stress and anxiety and promotes a sense of well-being. Community gardening, in particular, can decrease feelings of isolation and boost self-esteem. These gardens provide a space for people to connect with others and to work collaboratively. This is especially important for people who may be isolated or have limited social networks. 

How can you get involved in a community garden? 

The first step to getting involved is to find a garden in your area. Many cities have organized community garden programs that can help you find local garden plots, lend you tools or teach you how to garden. Local libraries, extension offices and community-based organizations are also great resources for finding community gardens and learning how to grow. (Pro tip: check with your local library to see if they have a seed bank that gives free seeds to library card holders.) Make sure to sign up early since some community gardens fill up quickly!  

If you don’t have a community garden in your area, consider starting one. Talk to your neighbors, local organizations or city officials about the benefits of community gardens and how you can start one in your neighborhood. You may be surprised at how many people are interested in getting involved and how much support you can get from your local community. 

Spring is the perfect season to get your hands dirty and start growing fresh fruits and vegetables. Whether you’re a seasoned gardener or a beginner, there’s a welcoming place for you in a community garden. So, what are you waiting for? Get out there and start gardening!

Author:  Gretchen Patch, MPH, CPH (Avid gardener and big supporter of extension offices 😊)

Senior Director  of Strategic Health Initiatives and Partnerships, ACSM

Originally published on April 25, 2023