Research ArticlePromoting physical activity in rural communities: Walking trail access, use, and effects
Introduction
T he health benefits of physical activity are now well-established. Physical activity contributes to a lower risk of coronary heart disease, as well as a variety of other chronic diseases including hypertension, non-insulin dependent diabetes (Type 2), colon cancer, osteoarthritis, and osteoporosis.1 Substantial health benefits appear to occur when going from a completely sedentary lifestyle to introducing modest amounts of physical activity.1 As with vigorous physical activity, light to moderate-intensity activity, such as walking, provides many health benefits. Positive outcomes of walking include maintaining weight loss longer,2 increasing high-density lipoprotein,3, 4 reducing blood pressure,5 and decreasing the risk of death from cardiovascular disease and cancer6, 7 while incurring a lower risk of injury and sudden death.8 Walking is the most common physical activity among the general population and in major subpopulations such as older persons and racial/ethnic minorities.8 It is especially promising as a focus of public health interventions because of its acceptability and accessibility, particularly among populations with a low prevalence of physical activity.8, 9 The current public health recommendation is for adults to accumulate at least 30 minutes of moderate-intensity physical activity on most, and preferably all, days of the week.10This guideline is generally consistent with the recommendation from the U.S. Surgeon General.1Despite the positive effects of physical activity, more than one quarter of the American population remains completely inactive and the prevalence of inactivity is highest in rural areas of the United States.11
To promote physical activity, more environmental and policy strategies are needed to change the physical and sociopolitical environments.12 Environmental and policy approaches may be especially indicated as a complement to more frequently used individual behavior and lifestyle modification strategies because they can benefit all people exposed to the environment rather than focusing on changing the behavior of one person at a time.12, 13, 14, 15 Strategies often include providing facilities and programs that are not currently available to the population. Examples of environmental and policy approaches to increase physical activity include walking and bicycle trails, liability legislation, zoning and land use, mall walking programs, building construction that encourages physical activity, policies and incentives promoting physical activity during the workday, and policies requiring comprehensive school physical health education programs.14, 15 Among these, establishing walking trails is a relatively low-cost intervention that may facilitate walking by reducing barriers related to convenience and accessibility and encouraging ongoing physical activity maintenance because trails become a permanent fixture in the community. Although such environmental and policy interventions to promote physical activity are being promoted widely,16, 17 there are sparse data on the uses and effects of these approaches on a community-wide basis.1, 14, 15 For example, in a recent review of the effectiveness of environmental and policy interventions in promoting physical activity, Sallis et al.15 identified only seven published, English-language studies.
To assess physical activity patterns and correlates, in particular walking trail uses and usefulness, we recently conducted a study of walking-related behaviors and attitudes. Its purposes were four-fold: (1) to describe the patterns and correlates of walking in the community, (2) to assess the availability of places to walk and perform other physical activities, (3) to determine the extent of walking trail use and possible effects on rates of physical activity, and (4) to describe attitudes toward the trails and their uses that may serve as barriers or enablers.
Section snippets
Intervention activities
Environmental and policy interventions are being conducted in two community-based intervention projects (i.e., the Bootheel and Ozark Heart Health projects) in 12 rural, southeastern Missouri counties, comprising a population of approximately 280,000. These projects are collaborations between the Missouri Department of Health and the Prevention Research Center at Saint Louis University. Compared with the rest of Missouri and the United States, this region has significantly more poverty, is
Results
The sociodemographic characteristics of the study population are shown in Table 1. The sample was generally representative of the overall population of the region, although it slightly underrepresented younger persons, males, and African Americans.
Overall, 44.9% of respondents had walked in the past month for exercise and 19.5% had walked at a level of five or more times per week and 30 minutes or more per occasion (“regular” walking). These variables were also examined within sociodemographic
Discussion
Researchers and practitioners recommend the building of walking trails as a useful environmental and policy intervention to promote physical activity.15, 16 To the best of our knowledge, this is the first U.S. study to systematically examine the descriptive characteristics, correlates, and possible effects of walking-trail development. As such, there is little literature with which to compare our results. Earlier cross-sectional studies have shown that numerous environmental variables are
Acknowledgements
This study was funded in part through the CDC contract U48/CCU710806 (Centers for Research and Demonstration of Health Promotion and Disease Prevention), including support from the Community Prevention Study of the NIH Women’s Health Initiative. Additional support was provided by the Cardiovascular Risk Reduction Targeted Health Initiative of the Missouri Department of Health and CDC cooperative agreement U58/CCU700950–14, the Behavioral Risk Factor Surveillance System.
The authors are grateful
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