County Health Rankings & Roadmaps, A Healthier Nation, County by County

The County Health Rankings models and measures

Our Approach

The County Health Rankings model of population health

What can I do?

Action Center

Explore guides and tools for improving health.

What Works for Health

Explore programs and policies that work!

What can I learn from others?

Reports

Key findings from the last four years of County Health Rankings and other national reports.

County-by-County Blog

Project updates, commentaries, events and news about health across the nation from the County Health Rankings & Roadmaps team.

Places for physical activity

Evidence Rating

Scientifically Supported

Health Factors

Enhancing access to places for physical activity involves changes to local environments that create new opportunities for physical activity or reduce the cost of existing opportunities (e.g., creating walking trails, building exercise facilities, or providing access to existing nearby facilities). Increased access is typically achieved in a particular community through a multi-component strategy that includes training or education for participants (CG-Physical activity). Such efforts are often implemented in low income neighborhoods.

Expected Beneficial Outcomes (Rated)

  • Increased physical activity

  • Improved physical fitness

Other Potential Beneficial Outcomes

  • Reduced obesity rates

Evidence of Effectiveness

There is strong evidence that improving access to places for physical activity increases physical activity and improves physical fitness in urban, rural, and suburban areas (CG-Physical activity, , CDC MMWR-Khan 2009, CETRT, TRB 2005, Cohen 2012, ALR-Umstattd Meyer 2015). Access itself is also strongly associated with high levels of physical activity () and lower obesity rates among adolescents (Dunton 2009).

Increasing access to places for physical activity in conjunction with efforts to address quality, cleanliness, and any safety or security concerns of such facilities over the long-term may be more effective at increasing physical activity levels than increasing access alone (TRB 2005). Research suggests that considering all types of weather such as freezing temperatures and rain when implementing a plan to increase access to places for physical activity can improve the effectiveness of the plan, particularly in cold weather states (Copeland 2011).

Overall, individuals with higher socio-economic status have been shown to have greater access to physical activity centers than those with lower socio-economic status (ALR-Disparities 2011, Gordon-Larsen 2006). Among North Carolina middle school students, living in socioeconomically disadvantaged rural areas is also associated with fewer places for physical activity and higher rates of obesity ().

Impact on Disparities

Likely to decrease disparities

Implementation Examples

National non-profit organizations work to increase access to places for physical activity in all 50 states, for example, Rails to Trails (RTT), YMCAs (YMCA-Fitness), JCCs (JCC-Fitness), the American Community Gardening Association (ACGA), the National Recreation and Park Association (NRPA-Impacting communities), and American Trails (American Trails-Map).

Efforts to increase access to places for physical activity are underway at the local, regional, and state level. Such efforts can be broad community initiatives that encompass policy, systems, and environmental changes, as in Hamilton County, OH (WeThrive-Community wellness) or specific projects such as renovating and promoting the use of a high school track, as in the Yancey County Schools in Burnsville, NC (AHRQ HCIE-Martin). Communities have created walking trails with fitness stations along the way, for example the Biser Fitness Trail in Gettysburg, PA (PA-Fitness trail). Many state health departments participate in community-based coalitions to support efforts to increase access to places for physical activity, as in Texas (TX DSHS-Walking trail) and Maine (HMP-Places for PA). Other states have developed statewide plans to increase access to places for physical activity, as in Oregon (NCO-OR PA plan).  

As of 2014, Arkansas, California, Kansas, and Texas enacted legislation to enable or encourage joint use agreements for school facilities as one way to increase access to places for physical activity (NCSL Winterfeld-Obesity prevention 2014). Nationally, reports estimate between 64% and 97% of middle and high schools allow community-sponsored use of their physical activity facilities by youth outside of normal school hours (CDC-Physical activity 2011).

Implementation Resources

NCPPA - National Coalition for Promoting Physical Activity (NCPPA). About resources & reports.

CDC-Healthy places - Centers for Disease Control and Prevention (CDC). Healthy places: Additional resources.

WHO-Edwards 2008 - Edwards P, Tsouros AD. A healthy city is an active city: A physical activity planning guide. Copenhagen, DK: World Health Organization Europe (WHO-E); 2008.

PFP-Physical activity - Partnership for Prevention (PFP). Places for physical activity: Facilitating development of a community trail and promoting its use to increase physical activity among youth and adults: An action guide. Washington, DC: Partnership for Prevention (PFP); 2008.

HealthPartners-CHA - HealthPartners Institute for Education and Research. Community health advisor (CHA): Resource for information on the benefits of evidence-based policies and programs: Helping communities understand, analyze, and model costs.

CDC-DNPAO data - Centers for Disease Control and Prevention (CDC), Division of Nutrition Physical Activity and Obesity (DNPAO). Nutrition, physical activity and obesity: Data, trends and maps online tool.

LHC-Rockeymoore 2014 - Rockeymoore M, Moscetti C, Fountain A. Rural Childhood Obesity Prevention Toolkit. Leadership for Healthy Communities (LHC). 2014.

CDC-Park HIA toolkit - Centers for Disease Control and Prevention (CDC). Healthy places: Parks and trails health impact assessment (HIA) toolkit.

ChangeLab-Winig 2013 - Winig B, Ackerman A, Gladstone E. This Land Is Our Land: A Primer on Public Land Ownership and Opportunities for Recreational Access. ChangeLab Solutions; 2013.

CDC-Belza 2015 - Belza B, Allen P, Brown D, et al. Mall walking: A program resource guide. University of Washington Health Promotion Research Center (UW HPRC), Centers for Disease Control and Prevention (CDC); 2015.

HOST-PA - Healthy Out-of-School Time (HOST) Coalition. Resources: Physical activity (PA).

WeThrive-Toolbox - WeThrive!, Hamilton County Public Health. Toolbox and resources used as part of the WeThrive! initiative.

Citations - Evidence

* Journal subscription may be required for access.

Brownson 2006* - Brownson RC, Haire-Joshu D, Luke DA. Shaping the context of health: A review of environmental and policy approaches in the prevention of chronic diseases. Annual Review of Public Health. 2006;27:341–70.

CG-Physical activity - The Guide to Community Preventive Services (The Community Guide). Physical activity.

ALR-Disparities 2011 - Active Living Research (ALR). Do all children have places to be active? Disparities in access to physical activity environments in racial and ethnic minority and lower-income communities. Princeton: Robert Wood Johnson Foundation (RWJF); 2011.

CETRT - Center of Excellence for Training and Research Translation (CETRT). Find interventions. UNC Center for Health Promotion and Disease Prevention (HPDP).

TRB 2005 - Committee on Physical Activity, Health, Transportation, and Land Use. Does the built environment influence physical activity? Examining the evidence. Washington, DC: Transportation Research Board (TRB), Institute of Medicine (IOM), National Academy of Sciences; 2005: TRB Special Report 282.

Gordon-Larsen 2006 - Gordon-Larsen P, Nelson MC, Page P, Popkin BM. Inequality in the built environment underlies key health disparities in physical activity and obesity. Pediatrics. 2006;117(2):417-24.

CDC MMWR-Khan 2009 - Khan LK, Sobush K, Keener D, et al. Recommended community strategies and measurements to prevent obesity in the United States. Morbidity and Mortality Weekly Report (MMWR). 2009;58(RR-07):1-26.

Wolch 2011* - Wolch J, Jerrett M, Reynolds K, et al. Childhood obesity and proximity to urban parks and recreational resources: A longitudinal cohort study. Health & Place. 2011;17(1):207-14.

Dunton 2009 - Dunton GF, Kaplan J, Wolch J, Jerrett M, Reynolds KD. Physical environmental correlates of childhood obesity: A systematic review. Obesity Reviews. 2009;10(4):393–402.

Copeland 2011 - Copeland K, Sherman SN, Khoury JC, et al. Wide variability in physical activity environments and weather-related outdoor play policies in child care centers within a single county of Ohio. Archives of Pediatrics & Adolescent Medicine. 2011;165(5):435-42.

Edwards 2013* - Edwards MB, Bocarro JN, Kanters MA. Place disparities in supportive environments for extracurricular physical activity in North Carolina middle schools. Youth & Society. 2013;45(2):265–85.

Cohen 2012 - Cohen DA, Marsh T, Williamson S, Golinelli D, McKenzie TL. Impact and cost-effectiveness of family fitness zones: A natural experiment in urban public parks. Health & Place. 2012;18(1):39–45.

ALR-Umstattd Meyer 2015 - Umstattd Meyer MR, et al. Physical activity-related policy and environmental strategies to prevent obesity in rural communities: A systematic review. 2015 Active Living Research (ALR) Annual Conference. 2015.

Citations - Implementation Examples

* Journal subscription may be required for access.

ACGA - American Community Gardening Association (ACGA). Locate your nearest community garden.

HMP-Places for PA - Healthy Maine Partnerships (HMP). Enhanced access to places for physical activity: Action packet. Augusta: Maine Department of Human Services; 2004.

CDC-Physical activity 2011 - National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). Youth physical activity and program highlights, 2011. Atlanta: Centers for Disease Control and Prevention (CDC); 2011.

RTT - Rails to Trails Conservancy. Inspiring movement.

YMCA-Fitness - Young Men’s Christian Association (YMCA). Health, well-being & fitness.

WeThrive-Community wellness - WeThrive!, Hamilton County Public Health. WeThrive! Community wellness in action.

JCC-Fitness - Jewish Community Center Association (JCC), DiscoverJCC.com. Programs and services at JCCs of North America: Health & fitness.

NRPA-Impacting communities - National Recreation and Park Association (NRPA). Impacting communities: Health and wellness.

NCSL Winterfeld-Obesity prevention 2014 - Winterfeld A. State actions to reduce and prevent childhood obesity in schools and communities: Summary and analysis of trends in legislation. National Conference of State Legislators (NCSL). 2014.

AHRQ HCIE-Martin - Martin C. School system renovates high school track and promotes its availability to the community, leading to increased use by students and residents. Rockville: AHRQ Health Care Innovations Exchange.

American Trails-Map - American Trails, National Trails Training Partnership. The world's largest online trails resource: Find state by state trails.

PA-Fitness trail - Borough of Gettysburg Pennsylvania (PA). Biser fitness trail and walking path located within the Gettysburg Regional Recreation Park.

TX DSHS-Walking trail - Texas Department of State Health Services (TX DSHS), Chronic Disease, Community & Worksite Wellness Program. How to build a walking trail.

NCO-OR PA plan - Nutrition Council of Oregon (NCO), Oregon Coalition for Promoting Physical Activity, Oregon Department of Human Services Physical Activity and Nutrition Program. A healthy active Oregon: Statewide physical activity and nutrition plan 2007-2012 (OR PA plan).

Date Last Updated

Sep 1, 2015