Parks, recreation and public health: parks and recreation improve the physical and mental health of our nation - Research Update

There's increasing evidence that using park and recreation services has a positive relationship to individual health (Godbey; Roy; Payne & Orsega-Smith, 1998; Hodges & Henderson, 1999; Iwasaki, Zuzanek & Mannell, 2001; Tinsley, Tinsley & Croskeys, 2002; Wolf, 1998; Yau & Packer, 2002). In the past, the association between use of park and recreation services and personal health has been overlooked for two reasons: the traditional definition of health was limited to the absence of disease, vitality and the life expectancy, and researchers hadn't looked beyond the direct benefits of park and recreation services (Kanters, 1996). Today, Americans have shifted from a medical model to a more holistic model of health, which emphasizes proactive health promotion and disease prevention strategies (Payne, Orsega-Smith, Godbey, & Roy, 1998). The purpose of this research update is to review what current research has to say about the holistic health benefits of park and recreation services.

Health Benefits According to Park Users

When health is viewed holistically as a multi-dimensional construct including physical, psychological and social components, the benefits of park and recreation services to these components of health are easily recognized. One large-scale study undertaken within Cleveland Metroparks examined the relationship between park use and individual health among people age 50 and older. Findings showed that approximately two-thirds of older park visitors were highly or moderately physically active while in these parks (Godbey et al., 1998). Active park users were healthier than passive users and non-park users on a number of measures, such as body mass index (a ratio between weight and height), diastolic blood pressure, systolic blood pressure, depression score and perception of general health. Among those 65 and older, level of physical activity in the park was the most important positive predictor of body mass index. Additional factors associated with less likelihood of depression included the size of one's social network, general level of physical activity and frequency of contact with friends during park and recreation participation.

Several studies have examined health benefits of park use as they relate to racial and ethnic groups. Tinsley et al. (2002) found that the most salient psychological benefits reported by older urban park users from four ethnic groups (African Americans, Asians, Caucasians and Hispanics) were immediate pleasure seeking, the opportunity to engage in non-challenging activities and the chance to be with other people. They also found no gender difference in the psychological benefits respondents reported from their park visits. However, significant differences were found among various ethnic groups regarding their park usage, ratings of perceived benefits and the social milieu within which they visited the park. These findings are consistent with Ho et al.'s (Ho, Sasidharan, Elmendorf, Graefe & Godbey, in review) analysis of local park visitation and recreation preferences among six ethnic groups in Atlanta and Philadelphia. In this study, ethnicity played an important role in shaping visitors' perception of benefits (e.g., improved overall health) and of local park and recreation areas. These ethnic differences were consistent for males and females. For instance, in general, all ethnic groups agreed that local park and recreation areas contributed to overall health. Japanese showed the highest agreement toward improved overall health, closely followed by Chinese, while Koreans and African Americans rated health as a benefit lowest among all groups.

Physical Activity in Paths

Several studies have illustrated that the majority of park users were physically active during their park visits (Godbey et al., 1998; Raymore & Scott, 1998; Scott, 1997; Tinsley et al., 2002). Godbey et al. reported that about seven out of 10 park visitors enjoyed a moderate to vigorous level of physical activity (e.g., walking 21-45 minutes, biking, jogging, hiking, etc.), and that the average visitor spent approximately half of his or her time walking while in parks. In Tinsley et al.'s study, vigorous physical exercise was a salient benefit of the activities that the participants pursued during their park visits.

Additionally, in a study examining the recreational experiences in urban parks and forests among various ethnic groups, Sasidharan (2001) found that social activities (e.g., talking with friends, playing with children, playing board games, etc.), physical exercises (e.g., running, walking, bicycling, etc.), and food-related activities (e.g., picnicking, eating, barbecuing, etc.) were rated highest in regard to visitors' activity participation pattern during their visit to parks or forests. He further indicated that the six ethnic groups differed significantly in terms of frequency of participation in physical exercises. Whites/Anglos participated more frequently than the other groups, followed by Hispanics/Latinos, African Americans, Koreans and Chinese, while Japanese rated lowest among all groups.

Another study assessed physical and psychosocial outcomes of participation in a community-based senior wellness program (Orsega-Smith, Payne & Godbey, in review). Members voluntarily completed a functional fitness test every six months, as well as a questionnaire that measured participation rates and psychosocial aspects of physical activity (i.e., self-efficacy, social support and perceived benefits). Significant improvements in endurance and flexibility were documented for the sample at large. Controlling for participation level (i.e., low, moderate and high), those moderately involved in the senior wellness program showed the greatest gains in endurance. Self-efficacy and exercise-based social support from friends was higher for those in the low and high participation groups than the moderate group. There was a positive relationship between family-based social support for exercise and participation. The results demonstrate that community-based physical activity programs--ones that emphasize enjoyable physical activity, social interaction with peers and peer-led activities--are viable contexts for the delivery of senior exercise/physical activity programs for older adults.

Stress-Reduction Benefits of Park Use

Godbey et al. (1998) also found that stress reduction (e.g., stress relief, clearing one's mind and feeling good) and exercise were the most common benefits that older park users ascribed to their park visits. Similarly, in a study examining the relationship among stress, park-based leisure and physiological/psychological health in older adults, Orsega-Smith, Mowen, Payne and Godbey (in review) found that, for those with higher body mass or higher blood pressure, a longer length of stay in the parks could be viewed as a strategy to reduce stress and to improve their physical health.

Godbey and Blazey (198s) explored the leisure behavior of 695 older adults (55 and older) who primarily participated in light to moderate aerobic activity in urban parks. Approximately one-half reported that they were in a better mood after visiting the park. More and Payne (1978) found that participants' negative moods decreased after leaving the park, and that park users reported lower levels of anxiety and sadness. Hull and Michael (1995) sought to determine if setting (indoor versus outdoor nature) played a significant role in shaping people's moods. Interviews of 186 nature recreationists revealed an interactive effect of stress and length of stay in the park (Hull & Michael, 1995). The longer the participants stayed, the less stressed they became. Additionally, they found that respondents felt significantly calmer and less anxious at the park than at home. Overall, results indicated that, in parks, people begin their recreation experiences in a better mood and remain in better moods.

As a whole, these studies indicated that outdoor recreation and park use might improve positive moods, decrease negative moods and alleviate stress. Regular park use may have long-term benefits for health and well being because the benefits of the activities and the environment may have a cumulative effect on individuals.

Furthermore, research has found that just the act of driving by parks and green spaces is related to stress relief. Parsons and colleagues (1998) exposed subjects who had just experienced an induced stressful event to one of four different simulated drives (forest/rural areas, golf courses, urban scenery and mixed roadside scenery). Subjects who engaged in a nature-based simulated drive (forest/rural areas, golf courses) recovered more quickly from stressful situations than those whose drives were dominated by built structures.

Social Support, Self-Determination and Stress Reduction

While some people assume that stress has a negative effect on health and is a major cause of illness, recent studies have demonstrated that whether a stressful event has a positive or negative effect on an individual depends on the protective factors he or she has (Iso-Ahola & Park, 1996; Iwasaki et al., 2001). Two factors strongly associated with use of park and recreation services that could help people moderate the negative effects of stress on heath are social support and self-determination (Iso-Ahola & Park, 1996).

While social support is well recognized for its buffering effect, another perspective in regard to its importance is also worth mentioning. Friendship and companionship generated through participating in shared activities is an important human need that motivates people to park and recreation participation (Coleman & Iso-Ahola, 1995; Iso-Ahola & Park, 1996). In terms of self-determination, if people regard park and recreation participation as freely chosen and a pleasurable experience, they may participate for a long time and feel committed to the activities, which can contribute to psychological well-being.

Observing Nature in Parks and Associated Benefits

Although many different benefits are associated with using local park and recreation services, observing nature was an important variable that emerged in the analysis of park benefits. This is especially true as the percentage of people living in urban areas continues to increase. Local park and recreation areas provide a space for people to escape from routine and to be close to nature. Godbey et al.'s study (1998) found that, regardless of activity, interaction with the natural environment, including scenery, wildlife and aesthetics were the most frequently reported benefits of using the parks among older park visitors. Similarly, Tinsley et al. (2002) reported that the natural features of the park (e.g., trees and water/lakefront) were the preferred features of Lincoln Park users (about half of all visitors), followed by the appreciation of the flower gardens and the use of beaches.

Overall Health of Park and Recreation Users

In terms of overall health, local park and recreation users reported fewer visits to a physician for purposes other than check-ups than did non-park users, even when controlling for the effects of age, income, education level, health status and other possibly influencing factors (Godbey et al., 1998). As for personal health ratings, active park users have better self-reported health and show other indicators of better health than do passive users and non-park users.

Implications

The evidence that park and recreation use contributes to better health is increasing during a period of time in which a substantial percentage (about one-third) of Americans are sedentary (Crespo, Keteyian, Heath, & Sempos, 1996; Robert Wood Johnson Foundation, 2001; Sallis, Bauman, & Pratt, 1998). For example, more than 25 percent of all women are completely inactive, more than 60 percent of adult women don't achieve the recommended amount of physical activity (30 minutes of moderate activity per day) (Bialeschki, 1999) and about one-third of the population age 50 and older is sedentary (Robert Wood Johnson Foundation). These estimates are even higher for African Americans, Hispanics and Pacific Islanders (Crespo, Smit, Anderson, Carter-Pokras, & Ainsworth, 2000). How researchers and practitioners increase people's use of local park and recreation services to achieve optimal health has therefore become increasingly important.

Sallies et al. (1998) proposed two approaches to reach this objective: environmental and policy interventions. Environmental interventions include the natural and constructed environments. Shaded areas and lighted trails, for example, could be offered to facilitate participation in case of hot weather, bad air pollution and concern for safety. Increasing funding to develop facilities and programs used for physical activity purposes also seems appropriate. The policy interventions include a variety of strategies, such as incentive programs and social marketing campaigns. For instance, it may be helpful to develop polices that provide incentives for exercising more or disincentives for exercising less. Further research is needed, however, to conceptualize the environmental and policy interventions and to evaluate their impacts.

In addition, an important issue related to health care services has been proposed--whether the existence of health benefits could be translated into reduced health care costs (Bright, 2000; Godbey et al., 1998; Payne, Orsega-Smith, Spangler & Godbey, 1999). Considering the high expenditures for health care services in the U.S.--estimated at 12 percent to 15 percent of gross domestic product, especially among older Americans (Teague et al., 1997; Himes, 2001)--the potential cost savings associated with participation in park and recreation services have drawn increased attention. Moreover, the 75 million baby boomers currently between the ages 39 and 57 will turn age 65 and older between 2010 and 2020. As this aging process occurs, demands on the health care system will be even greater.

On the basis of the literature, it's clear that benefits received from participation in park and recreation are health-related. In other words, using park and recreation services has a positive relation to personal health. This puts local park and recreation departments in a position of greater importance in the community. A clear perspective on the potential benefits will allow park and recreation services to experience a paradigm shift to re-conceptualize their management strategy toward benefit-based management, which will contribute to the well-being of all individuals.

RESEARCH INTO ACTION: MANAGING PARKS FOR PUBLIC HEALTH

Research suggests that park and recreation services sponsored by local governments are perceived to contribute to personal health by a broad cross-section of users, and are used in ways that have considerable physical activity and stress reduction value. Those who use local parks and participate in recreation programs and services appear to be in disproportionately better health than those who aren't users. Park users are also less likely to be obese than the general population.

The findings reviewed for this research update, while in need of greater substantiation, have broad implications for the management of park and recreation services. These implications are as follows:

Park and recreation agencies must undergo a re-positioning as part of the health services sector of government. This means marketing of such services must identify and communicate the health benefits of participation. It doesn't mean that park and recreation agencies must make a massive effort to begin new programs, although some may be in order. Rather, it means that existing programs and facilities must be interpreted to the public in ways that promote the health benefits of participating.

Park and recreation personnel must, in many cases, undergo a paradigm shift in their own conceptualization of their mission. Park and recreation agencies must take steps to better appreciate their roles in maintaining and enhancing the health of children and adults. Ironically, many in the health community are finally recognizing the contribution of park and recreation services to health and wellness, even if park and recreation professionals don't.

There needs to be exploration of opportunities for partnerships and other synergistic relations between a wide variety of organizations involved with health, including hospitals, health maintenance organizations, public health departments, insurance companies, nonprofit organizations concerned with chronic diseases, such as the American Heart Association, and state and federal government organizations concerned with health.

Specific programs targeted to maintaining or improving health need to be developed and promoted. Additionally, existing programs and facilities need to be presented to the public in ways that make the positive health implications of participation clear.

Practical research needs to be undertaken to demonstrate the health consequences of participation, including simple measures of the amount of physical activity involved in participation, e.g., visitors to this park walk for an average of 45 minutes. While research concerning the role of park and recreation services in various aspects of health is in its infancy, the results to date indicate the possibility of a greatly expanded role in this arena.

Park and recreation services of local governments contribute to maintaining and enhancing good health. The health benefits of participation in park and recreation services must be effectively communicated to the public, even as park and recreation professionals must better understand these benefits. There's a need for more partnering with health-related agencies, development of programs to facilitate health and research to document the health benefits of participation in park and recreation services.

References

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Bright, A. D. (2000). The role of social marketing in leisure and recreation management. Journal of Leisure Research, 32, 12-17.

Coleman, D. J., & Iso-Ahola, S. E. (1993). Leisure and health: The role of social support and self-determination. Journal of Leisure Research, 25, 111-128.

Crespo, C. J., Keteyian, S. J., Heath, G. W., & Sempos, C. T. (January, 1996). Leisure-time physical activity among US adults. Arch Intern Med, 156, 93-98.

Crespo, C. J., Smit, E., Anderson, R. E., Carter-Pokras, O., & Ainsworth, B. E. (2000). Race/ethnicity, social class and their relation to physical inactivity during leisure time: Results from the Third National Health and Nutrition Examination Survey, 1988-1994. American Journal of Preventive Medicine, 18, 46-53.

Godbey, G., & Blazey, M. (1983). Old people in urban parks: An exploratory investigation. Journal of Leisure Research, 15, 229-244.

Godbey, G., Roy, M., Payne, L., & Orsega-Smith, E. (1998). The Relation Between Health and Use of Local Parks. National Recreation Foundation.

Himes, C. L. (2001). Elderly Americans. Population Bulletin, 56(4). Washington, DC: Population Reference Bureau.

Ho, C.-H., Sasidharan, V., Elmendorf, W., Graefe, A., & Godbey, G. (2002). Gender and ethnicity differences in local park visitation and recreation preferences. Manuscript submitted for publication.

Hodges, J. S., & Henderson, K. A. (1999). Promoting the physical activity objectives in the Surgeon General's report: A summary. Journal of Physical Education, Recreation, & Dance, 70(3), 40-41.

Hull, R. B., & Michael, S. E. (1995). Nature-based recreation, mood change, and stress restoration. Leisure Sciences, 17, 1-14.

Iso-Ahola, S. E., & Park, C. J. (1996). Leisure-related social support and self-determination as buffers of stress-illness relationship. Journal of Leisure Research, 28, 169-187.

Iwasaki, Y., Zuzanek, J., & Mannell, R. C. (2001). The effects of physically active leisure on stress-health relationships. Canadian Journal of Public Health, 92, 214-218.

Kanters, M. A. (January/February, 1996). The health benefits of parks and recreation. Illinois Parks & Recreation, 27-30.

More, T. A., & Payne, B. R. (1978). Affective responses to natural areas near cities. Journal of Leisure Research, 10, 7-12.

Orsega-Smith, E., Mowen, A. J., Payne, L. L., & Godbey, G. (2002). The interaction of stress and park use on psycho-physiological health in older adults. Manuscript submitted for publication.

Orsega-Smith, E., Payne, L., & Godbey, G. (2001). Health related outcomes associated with participation in a community-based program for older adults. Manuscript submitted for publication.

Parsons, R., Tassinary, L. G., Ulrich, R. S., Hebl, M. R., & Grossman-Alexander, M. (1998). The view from the road: Implications for stress recovery and immunization. Journal of Environmental Psychology, 18, 113-140.

Payne, L., Orsega-Smith, E., Godbey, C., & Roy, M. (October, 1998). Local parks and recreation and the health of older adults: The results of an exploratory study. Parks & Recreation, 56-63.

Payne, L., Orsega-Smith, E., Spangler, K. J., & Godbey, G. (October, 1999). Local parks and recreation: For the health of it. Parks & Recreation, 72-77.

Raymore, L., & Scott, D. (1998). The characteristics and activities of older visitors to a metropolitan park district. Journal of Park and Recreation Administration, 16(4), 1-21.

Robert Wood Johnson Foundation. (May 2001). National Blueprint: Increasing physical activity among adults age 50 and older. Princeton, NJ: Author.

Sallis, J. F., Bauman, A., & Pratt, M. (1998). Environmental and policy interventions to promote physical activity. American Journal of Preventive Medicine, 15(4), 379-397.

Sasidharan, V. (2001). The urban recreation experience: An examination of multicultural differences in park and forest visitation characteristics. Unpublished doctoral dissertation, The Pennsylvania State University, University Park, PA.

Scott, D. (1997). Exploring time patterns in people's use of a metropolitan park district. Leisure Sciences, 19, 159-174.

Teague, M. L., McGhee, V. L., Rosenthal, D. M., & Kearns, D. (1997). Health promotion: Achieving high level wellness in the later years (3rd ed.). Dubuque, IA: Brown and Benchmark.

Tinsley, H. E. A., Tinsley, D. J., & Croskeys, C. E. (2002). Park usage, social milieu, and psychological benefits of park use reported by older urban park users from four ethnic groups. Leisure Sciences, 24, 199-218.

Wolf, K. (1998). Human dimensions of the urban forest. Seattle, WA: Center for Urban Horticulture, University of Washington.

Yau, M. K. S., & Packer, T. L. (2002). Health and well-being through T'ai Chi: Perceptions of older adults in Hong Kong. Leisure Studies, 21, 163-178.

Ching-Hua Ho is a doctoral candidate in leisure studies at Pennsylvania State University's College of Health and Human Development. Laura Payne, Ph.D., is an assistant professor in the Department of Leisure Studies at the University of Illinois, Urbana-Champaign. Elizabeth Orsega-Smith, Ph.D., is an assistant professor in the Department of Health & Exercise Sciences at the University of Delaware. Geoffrey Godbey, Ph.D., is a professor of leisure studies at Pennsylvania State University's College of Health and Human Development. For more information on this topic, contact Ching-Hua Ho at cxh472@psu.edu.

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