Associations between the physical environment and park-based physical activity: A systematic review

Accepted Manuscript

Associations between the Physical Environment and Park-Based Physical Activity: A Systematic Review Ru Zhang , Hagen Wulff , Yanping Duan , Petra Wagner PII: DOI: Reference:

S2095-2546(18)30098-X https://doi.org/10.1016/j.jshs.2018.11.002 JSHS 487

To appear in:

Journal of Sport and Health Science

Please cite this article as: Ru Zhang , Hagen Wulff , Yanping Duan , Petra Wagner , Associations between the Physical Environment and Park-Based Physical Activity: A Systematic Review, Journal of Sport and Health Science (2018), doi: https://doi.org/10.1016/j.jshs.2018.11.002

This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

ACCEPTED MANUSCRIPT

Highlights Paths/trails and lighting received convincing support in promoting park-based PA.



The association between incivilities and park-based PA was consistently positive.



Seven park environment characteristics were mixed in relation to park-based PA.



The density of and proximity to parks represented inconsistent evidence.

AC

CE

PT

ED

M

AN US

CR IP T



ACCEPTED MANUSCRIPT

Review Associations between the Physical Environment and Park-Based Physical Activity: A Systematic Review Ru Zhang a*, Hagen Wulff b, Yanping Duan a, Petra Wagner b Running title: physical environment and park-based PA

Affiliations: Department of Sport and Physical Education, Faculty of Social Sciences, Hong Kong Baptist University, Hong Kong, China

b

Institute of Exercise and Public Health, Faculty of Sport Sciences, University of Leipzig, Leipzig 04109, Germany

CR IP T

a

*Corresponding author

AN US

E-mail: [email protected]

AC

CE

PT

ED

M

Received: 2018-5-11 Revised: 2018-8-21 Accept: 2018-9-9

ACCEPTED MANUSCRIPT

Abstract Background: With an increase in the evidence for the associations between park-based physical activity (PA) and physical environments (especially park and neighborhood environments), researchers face an important challenge in interpreting and summarizing the evidence to develop environmental change interventions. An updated review is needed to better inform policymaking and environmental interventions. The current study aimed to systematically review the research on the associations of park-based PA with park and neighborhood environmental characteristics. Methods: We targeted English peer-reviewed articles from five electronic databases using keywords related to park-based PA, 2016 met all the eligibility criteria and were included in this review.

CR IP T

park environments, and neighborhood environments. Of the 4,071 identified papers, 25 studies published between 2008 and Results: The characteristics of physical environment that received consistent support included paths/trails, lighting, and incivilities (e.g., broken glasses and litter). Mixed findings were revealed for six park environmental factors (i.e., unspecified active facilities, playgrounds and skating areas, fitness stations, picnic areas, greenness, and park size) and two neighborhood environmental factors (i.e., park density and park proximity).

AN US

Conclusion: It can be concluded that paths/trails, lighting, and incivilities are three key physical environmental attributes of park-based PA. Given the inconsistent findings on park and neighborhood environmental factors, more robust designs such as prospective investigation are required.

AC

CE

PT

ED

M

Keywords: Neighborhood; Park environment; Physical environment; Park-based physical activity; Systematic review

ACCEPTED MANUSCRIPT

1.

Introduction

Providing free and accessible physical activity (PA) resources in natural sites is a promising strategy for increasing PA at the population level.1 In particular, urban parks have been widely recognized as key environmental sites that can provide individuals with a variety of active recreation and health benefits.2 Although experimental evidence has revealed that parkbased PA leads to greater cardiovascular, blood glucose, and mental benefits than the same amount of activity in non-green settings,3,4 parks are still not well utilized for PA by park visitors and those living in surrounding neighborhoods. Findings from park-use research indicate that more than 50% of individuals do not visit parks for active or passive activities during a typical week.5 It has also been reported that sedentary activities such as picnicking, sitting, and social interaction with families or

CR IP T

friends are very common in parks.6 Additionally, it has been reported that less than one third of those who were surveyed or observed as park visitors engaged in park-based PA.7

Promoting park-based PA requires a clear understanding of the underlying factors that influence active behaviors in parks. Based on the social ecological approach, PA can be understood as people’s interactions with their sociocultural and physical environments.2,8 Physical environments refer to the perceived and objective characteristics of the physical contexts in which behaviors are engaged and people live.2 Identifying the environmental attributes of PA is needed to develop effective

AN US

interventions to promote park-based PA at a population level.1 An increasing amount of cross-sectional and experimental evidence indicates that park environmental factors, such as the presence and condition of parks, aesthetics (e.g., greenness and park size), and crime-related safety, may influence park-based PA.9,10 The neighborhood environment may also play a role in increasing residents’ park-based PA, as people have to pass through their neighborhoods on the way to these parks. Several neighborhood environmental factors, such as street intersections, density and proximity of parks, and crime and traffic safety issues, have generally been identified to be associated with park-based PA.11,12

M

With an increase in the evidence of the associations between park-based PA and physical environments (especially park and neighborhood environments), researchers face an important challenge in interpreting and summarizing these findings when

ED

developing environmental change interventions to promote park-based PA. It is currently accepted practice to rely on literature reviews that have synthesized the empirical findings of previous studies to guide evidence-based research needs.13 Although the literature on the density of and proximity to parks in relation to PA has been synthesized, this review focused on total PA

PT

instead of context-specific PA in parks.14 Two reviews to date have summarized the environmental attributes of park-based PA.15,16 One review15 of qualitative studies found that park safety, aesthetics, supporting amenities, maintenance of features, and

CE

proximity to parks were important environmental factors associated with park-based PA. Another review16 of experimental studies revealed that conducting PA programs and renovation of park environments could promote PA in green spaces. However, these two reviews did not synthesize the cross-sectional or longitudinal findings from the literature on the

AC

associations between the neighborhood environment and park-based PA. To address the aforementioned limitations, the present study aimed to systematically review the research on the relationships between park-based PA and park and neighborhood environment characteristics. Specifically, this review addressed some limitations of previous reviews by combining park and neighborhood environment characteristics in relation to park-based PA and synthesizing the cross-sectional and longitudinal results. A clear picture of the current evidence on physical environmental attributes of park-based PA may help to develop interventions for improving park-based PA via changing physical environments.

2.

Methods

ACCEPTED MANUSCRIPT

Steps described in the following sections were undertaken in accordance with the recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.17 2.1 Eligibility criteria The identified studies from databases and hand-searching were eligible if they: (a) were published in English peerreviewed journals, (b) investigated park-based PA (i.e., any form of PA that were specifically engaged in parks), and (c) examined associations between park-based PA and at least one physical environment characteristic. Mixed-methods research, including quantitative analysis, was also taken into account. Articles were excluded from consideration if they: (a) provided only descriptive findings, (b) were qualitative studies, reviews, experimental studies, or reports, (c) combined several

CR IP T

environmental attributes as a composite score, and (d) focused on walking trails or open/green spaces that were not located within parks. 2.2 Information sources and search strategy

A literature search for the studies on associations between park-based PA and physical environments was conducted in the first week of December 2016. Five electronic databases (i.e., Medline, Embase, PsycINFO), SPORTDiscus and Web of Science) were searched for English peer-reviewed articles published by December 2016. Keyword searches within titles and abstracts

AN US

were undertaken for the following phrases: “park-based PA”, “park environment”, and “neighborhood environment” (see Appendix A). Reference lists from the identified literature and previously published reviews were also searched by hand. Corresponding authors were contacted if there was any missing information within published papers (e.g., research methods). 2.3 Study selection

We managed study selection using Clarivate Analytics EndNote X7.7 and have presented a flow chart of the selection processes in Figure 1. After removing duplicate articles identified via EndNote and hand-searching, the first author of this study

M

retrieved abstracts according to the inclusion criteria. Screening and exclusion of full-text articles was conducted by the first author and rechecked by the second author. Disagreements between researchers were resolved by group discussion. Findings of

ED

the remaining studies were organized for further analyses. ---Figure 1---

2.4 Data collection process and data items

PT

To organize findings of the eligible articles, a data extraction form was developed and piloted on a sample of the included studies (n = 10). Data collection was conducted by the first author and rechecked by the second author. For any inconsistencies,

CE

the authors had a discussion to reach a consensus. Two tables (Table 1 and Appendix B) were created by recording and coding the following data for each eligible article: (a) first author, publication year, and reference number; (b) sample characteristics, including country of origin, sample size of parks and participants, and participants’ gender and age; (c) study designs and

AC

measurements; and (d) main findings of physical environment characteristics. The direction of associations was coded as significant positive “+”, significant negative “–”, or nonsignificant “n.s.”. Superscript numbers and text fonts were added to distinguish between studies conducted with differences in age, gender, and measurements. ---Table 1---

In line with the rules from a previous review,13 records in the detailed table were further summarized and tabulated. Specifically, factors were not shown in the summarized tables unless three or more records were available. Furthermore, similar factors such as paths and trails were combined during data analyses. Additionally, a more general factor, such as “unspecified active facilities”, was created if the characteristic lacked specificity. Based on the classification of physical environmental factors in previous studies,18,19 variables in Appendix B were classified into four park environmental categories, including: (a) park features (i.e., active facilities and supporting amenities), (b) park condition (i.e., feature maintenance and incivilities), (c)

ACCEPTED MANUSCRIPT

park aesthetics (i.e., attractiveness, greenness, park size, and amount of shade), and (d) park safety (i.e., crime-related safety in parks). In addition, we coded three categories of neighborhood environmental factors, including: (a) walkability (i.e., park density and street connectivity), (b) park proximity (i.e., distance from residential homes to parks), and (c) neighborhood safety (i.e., traffic- and crime-related safety in the neighborhood). While crime and traffic safety are not characteristics of the physical environment, they were included in the present study because safety issues have intimate links with some physical environment characteristics such as lighting and incivilities (e.g., broken glasses and litter),5,20 and these can affect a specific site’s reputation as safe or unsafe. The definition for each of the physical environment variables is represented in Appendix C. Strength of evidence for the associations with park-based PA was assessed based on the criteria adopted from Sallis et al.13

CR IP T

2.5 Risk of bias in individual studies

The risk of bias for each eligible article was evaluated by adopting a formal assessment scale, which was developed for assessing the quality of cross-sectional and longitudinal studies.21 This scale has five items (see Appendix D), with a value of either 0 (i.e., absent or inadequately described) or 1 (i.e., explicitly described and present). Articles were assessed by two independent authors as having a score of low (i.e., 5), moderate (i.e., 3–4) or high (i.e., 0–2) risk of bias, depending on the accumulated scores of the five items. Inter-rater agreement was assessed. To synthesize a whole picture of evidence from the

AN US

eligible studies, Plotnikoff et al.21 suggested that all the articles, including those with a high risk of bias, would be included in the analyses. 3.

Results

3.1 Study selection

As shown in Figure 1, a total of 4,071 articles were identified in the study selection (databases, n = 4,067; and handsearching, n = 4). Among the 2,346 unique articles, 2,217 of which were discarded after evaluation of the abstracts, and the full

M

texts of the remaining 129 articles were examined for eligibility. Finally, 25 articles were selected and extracted, as shown in Table 1.

ED

3.2 Characteristics of eligible studies

A summary of study characteristics is shown in Appendix E. More than half of the identified studies (n = 16) were undertaken in the USA, with the remaining studies being conducted in Canada (n = 4), Australia (n = 2), Brazil (n = 1), and

PT

Colombia (n = 1). A single study took place both in the United States of America and Belgium. A total of two studies stratified their results by age, 10 studies reported one age subgroup, and 13 studies reported a combined age. A total of six studies showed

CE

findings stratified by gender, and the other 19 studies combined gender. All the eligible studies employed cross-sectional designs. A total of 15 studies measured self-reported park-based PA, and 10 studies measured PA with direct observation instruments. Self-reported measures were used in four studies to assess physical environment characteristics, 16 studies used

AC

objective tools, and five studies used both perceived and objective measures. Park environmental factors in relation to parkbased PA were examined in eight studies, neighborhood environmental factors were examined in eight studies, and both park and neighborhood environmental factors were examined in nine studies. Most of the studies were analyzed at the unit of the individual and adjusted for more than two types of covariates. 3.3 Risk of bias assessment Two authors of the present study independently assessed the selected studies for bias (inter-rater agreement = 92%), shown in Appendix D. The majority (i.e., 19 out of 25) of studies had a moderate risk of bias (i.e., scores of 3 and 4), five studies received a score of 5, equating to a low risk of bias, and only one study had a score of 2. Half of studies (n = 13) adopted a randomization method in their sampling selection. Most of the studies presented supporting evidence for the validity or

ACCEPTED MANUSCRIPT

reliability of the measures of park-based PA (n =15) and environmental factors (n = 19). All the studies included power calculation details. 3.4 Physical environmental correlates Table 2 represents a summary of findings about the associations of park-based PA with park and neighborhood environment factors. ---Table 2--Park environmental correlates of park-based PA Of the 17 studies that examined the associations between park-based PA and park environments, 18 park environmental

CR IP T

factors related to features, conditions, aesthetics, and safety were identified and appeared in three or more records. Most of the park features (10 out of 11) had an unrelated or inconsistent association with park-based PA. In contrast to these unexpected findings, paths/trails and lighting were consistently positive attributes of park-based PA. Trails and paths received greatest support (71% positive) for promoting park-based PA, regardless of age and gender. The presence of artificial lighting (or light poles) that allowed the use of parks at night was also important. Two studies

9,20

found that the presence of lighting was

positively related to increases in park-based PA for teens, especially for female teens.

AN US

For park condition, a significant relationship with park-based PA was only found for incivilities but not for feature maintenance. Three out of five records identified a positive association for incivilities.5,22,23 In addition to an observation study that found positive evidence for incivilities,23 another two studies5,22 revealed that adults’ perceived park use for PA was positively related to self-reported or objectively measured park incivilities, while the relationship was not significant in children.24 Unexpected findings, however, were found for maintenance of park features. Most of the records (7 out of 9) indicated that lack of maintenance was not an important issue hindering park-based PA. In particular, the condition of sport

M

fields, playgrounds, and basketball counts was unrelated to park-based PA.25

Effects of greenness and park size on park-based PA may differ by age. The presence of greenness was found to be

ED

positively related to active park use in two adolescent samples.9,26 By contrast, green vegetation in parks did not yield significant evidence in increasing park-based PA in adults and older people.10,27 Moreover, Kaczynski and colleagues27,28 revealed that most findings related to park size were positively associated with adults’ park-based PA. On the other hand, three children or teens.9,26,29

PT

independent studies did not show evidence that park size plays an important role in higher levels of park-based PA among

CE

Evidence from four studies demonstrated a non-significant relationship between park-based PA and crime-related safety in parks. Although one study of American adolescents revealed a positive association between perceived safety in parks and selfreported park-based PA11, the association was not significant in a sample of American adults.5 Likewise, another study reported

AC

no relationship for objectively measured park safety in American boys and girls.30 In contrast, a negative correlation was found between observed park-based PA and perceived park safety in American adults.6 Neighborhood environmental correlates of park-based PA Findings related to five neighborhood environment factors including walkability (i.e., park density and street connectivity), park proximity, and neighborhood safety (i.e., traffic- and crime-related safety) are summarized in Table 2. Inconsistent evidence was found in relation to park density and street connectivity and their association with park-based PA. Despite one study that found a positive relationship between park density (parks with a 500-m buffer) and perceived park-based PA in Colombian seniors,31 a non-significant association was found in the same buffer distance in a sample of American teens.26 Inconsistent evidence was also revealed in two independent studies conducted by Kaczynski and colleagues.10,28 Kaczynski et al.28 found that the density of parks within an 800-m range of neighborhoods was positively related to increased reports of park-

ACCEPTED MANUSCRIPT based PA in Canadian females, adults, and seniors, but not in males. Another study by Kaczynski et al.10 revealed that the relationship between park density within one mile of homes and perceived park-based PA was significant in American adults but not in females, males, or older adults. Furthermore, unexpected evidence was revealed in street connectivity. A single record found a positive relationship between street connectivity and park-based PA.32 In contrast, Parra et al.31 revealed a negative relationship between objective street connectivity and perceived park-based PA in Colombian seniors. Two specific characteristics of street connectivity, the presence of minor roads and the number of lots, were unrelated to park-based PA among a sample of Australian children9. Park proximity played a greater role in promoting active park use among children and adolescents compared with adults

CR IP T

and older people. Having more accessible parks in neighborhoods could promote adolescents’ active park use. The current review revealed that both perceived and objectively measured park proximity received consistent support in relation to parkbased PA among young people.11,20,26 In contrast to the supportive evidence for teens, all of the records involving adults and older people found that park proximity has a limited association with park-based PA. Findings from two American samples (age range=18–98 years) indicated that there was a non-significant association between objectively measured park proximity and self-reported park-based PA.28,32 Consistent evidence was found for adult and older adult samples in Canada.33

AN US

For neighborhood safety, traffic- and crime-related safety were not significant in relation to park-based PA in more than 34% of the records. Although one study found a positive association between perceived traffic-related safety and increases in perceived park-based PA among Brazilian male teens,20 the same study found a non-significant association among female teens. In three additional studies, traffic-related safety was a non-significant factor.22,32,34 Most of evidence on crime-related safety was also revealed a non-significant relationship, except for one study in which perceived crime-related safety in the neighborhood was negatively related to American teens’ reports of park-based PA.34 Discussion

M

4.

4.1 Summary of evidence

ED

The present systematic review extends prior knowledge by summarizing studies on the associations between park-based PA and park and neighborhood environment characteristics. A key finding was that paths/trails, lighting, and incivilities were consistently associated with park-based PA and that several park environmental factors were identified as inconsistent (6 out of

PT

18) or non-significant (9 out of 19) correlates of park-based PA. For the neighborhood environment, we found that the density and proximity of parks demonstrated an inconsistent relationship with park-based PA, while street connectivity and the traffic-

CE

and crime-related safety within the neighborhood were non-significant factors. Parks containing a large variety of features may support a range of visitors’ activity needs. The current review has demonstrated consistent evidence for the positive influence of paths/trails and lighting on increases of park-based PA. The

AC

findings regarding trails/paths are consistent with two other reviews of the qualitative and experimental research.15,16 The link between trails/paths and park-based PA suggests that people are more likely to engage in walking, jogging, and cycling in parks when trails/paths are available. We also found that several park features, including playing and skating areas, fitness stations, and picnic areas, have the potential for increasing park-based PA, although the evidence was mixed. These findings are not consistent with the qualitative review,15 in which a variety of features such as playgrounds, structured activities, barbecues, and seating in parks were found to be important for generating activities among people using parks. The lack of consistency in findings is likely due to measurement error in objectively assessing park features.13 Most available objective measures of the park environment can be considered first-generation measures, which have well-documented limitations in reliability and validity.35 Future research is needed to improve the quality of measures by refining their use in various social-ecological contexts.

ACCEPTED MANUSCRIPT

In contrast to our expectations, incivilities were positively related to park-based PA. This result is inconsistent with the qualitative evidence that clean parks might promote park use.15 However, the positive association between incivilities and PA was revealed by Ding et al.,36 who found that individuals with higher perceptions of environment disorders such as broken glasses and litter were more likely to engage in PA. These findings can be understood that those who spend a larger amount of time in parks are more cognizant of park incivilities. Another possible explanation is that more frequent park use could contribute to less park cleanliness.5 Although park incivilities such as the presence of broken glass and overgrown grass suggest that the park has low level of aesthetics and safety,18 it is difficult to maintain a clean and aesthetic park environment if the park is visited by a large number of people.

CR IP T

Park size and greenness have been extensively studied, but their relationships with park-based PA received inconsistent support. The present review found that park size had no relationship with park-based PA among children or teenagers, while the association was mixed for adult and senior samples. These findings demonstrate that the acreage of park space has limited influence on young people’s park-based PA. One possible reason is that children and adolescents may pay greater attention to park facilities such as playgrounds and sports courts compared to park size. We also found that the relationship between greenness and park-based PA was mixed in adults and older adults but was positive in children and adolescents. This finding for

AN US

children and adolescents is similar to previous reviews in which the green environment is suggested to influence an increase in total PA12,36 and PA in green spaces.16 One possible mechanism proposed for the contribution of greenness to PA is that experiencing "green" spaces plays a key role in psychological benefits such as reduced negative emotions and increased energy.37

Although crime-related safety in parks has been extensively studied in the retrieved studies, we found limited support for its associations with park-based PA. The non-significant findings from the present review suggest that people engaging in park-

M

based PA may pay more attention to park features, but not to crime-related safety issues.5 In contrast, one review of qualitative research15 found that crime-related safety was positively associated with park-based PA among children and the elderly. A

ED

possible reason for the mixed evidence could be that crime-related safety concerns such as the presence of drug users and presence of lighting at night are more important for certain age and gender subgroups. The moderating effects of age and gender on the relationships between safety and total PA were reported in two of the reviewed studies.20,30 Differences in the

PT

measurements of safety across studies is another possible explanation for the inconsistent evidence. Further consideration is the necessity for developing adequate measures of perceptions of safety in parks.38

CE

Considering neighborhood environments, park density received inconsistent support for a positive association with parkbased PA. One possible explanation for the mixed findings across studies is that the association between park density and parkbased PA is likely to differ in buffer sizes and be influenced by confounding variables. It is possible that residents prefer parks

AC

within smaller buffers around their homes than those further away. The current review demonstrated that enhancing park-based PA was more likely as the number of parks within a small buffer of homes (e.g., 500 meters) increased, but not for the density of parks within a 1-mile buffer. This finding is in line with a systematic review by Bancroft et al.,14 in which smaller (compared with larger) buffer sizes had a greater link to objectively measured overall PA. Mixed findings were also identified in the association between park proximity and park-based PA. Thus, there is no conclusive evidence for the proposition that parks close to residents’ living places could encourage people to be active in those parks. Despite qualitative evidence from one review suggesting that distance to parks is an important factor that can encourage residents, especially children and older adults, to use parks for PA,15 the current review suggests that having an accessible park in neighborhoods is not always linked to using parks for PA. Similar mixed evidence also has been identified in two other reviews involving the influence of proximity to PA services.38,39 For example, Van Cauwenberg et al.38 found mixed evidence

ACCEPTED MANUSCRIPT

for a positive relationship between recreational or transport-related PA in older adults and increasing access to services. One possible explanation for the unexpected evidence is safety concerns in parks or neighborhoods. Some studies have revealed that crime-related safety issues in parks, such as insufficient lighting, sexual assault, and theft, could limit park-based visits or PA.6,15 Methodological issues, such as sample characteristics, potential covariates and moderators, and measure types (perceived and objective measures), are likely to increase the prevalence of inconsistent findings across studies.13 The extent to which the environmental attributes of park-based PA are generalizable across cultural contexts remains unexplored. Considering that most of the eligible studies were undertaken in Western countries, future studies outside North America, Australia, and Europe are

CR IP T

needed to test the generalization of the associations. Moreover, the findings regarding socio-demographic differences in the associations between physical environments and park-based PA remain inconsistent. Some studies found that the associations varied by age and gender,10, 29 while others showed that socio-demographic factors did not moderate the relationship between PA and parks.40 The inconsistency in these findings is likely to be explained by self-selection bias, differences in measurement tools, and/or cultural influences.40 How socio-demographic factors play a role (e.g., as covariates or moderators) in the relationship between the park environment and park-based PA requires further testing in future research.

AN US

Furthermore, the discrepancy in results is likely to be explained by the differences between perceived and objective measures. The low agreement between perceived and objectively measured park environmental characteristics (proximity to parks) may stem from the integration of objective environmental conditions captured via personal socio-demographic factors and social cognition.31, 40 The potential moderating effect of perception of physical environment on the relationship between objective environmental characteristics and PA is an additional explanation for the mixed and null results. For example, one study found that the associations of objective street interaction and land-use mix with PA were moderated via perceived

M

pedestrian infrastructure.40 Thus, investigating how social cognitive and perceived environmental factors can be integrated into

4.2 Limitations and strengths

ED

the objectively measured physical environment in the prediction of park-based PA is warranted in future research. The present study needs to be considered within the context of its limitations. First, the present study retrieved only English peer-reviewed articles and thus may contain biased findings. Articles published in non-English journals may have

PT

yielded different physical environment attributes of park-based PA. Second, the current review did not stratify the results by socio-demographic factors or measure types (perceived and objective measures) due to the limited number of eligible studies in

CE

the subgroups. Finally, this review did not systematize the intrapersonal and interpersonal factors or environment-level socioeconomic status in relation to park-based PA. This is because the purpose of this study was focused only on the modifiable components of the physical environment. Including other factors could provide policy makers with multiple strategies for

AC

enhancing park-based PA.

A primary strength of the current review is the context-specificity of environment-PA associations. This review systematized studies on the environmental correlates of PA undertaken in parks. Information on such environment-PA relationships could guide researchers in developing ecological models of park-based PA and further improve the design of environmental change interventions. A second strength is that the study included a comprehensive search strategy across various databases. Finally, the current review comprehensively examined various study designs through which physical environments and park-based PA were measured, including both perceived and objectively measured findings. 5 Conclusion It can be concluded that evidence for the associations between park-based PA and physical environments is limited. The environmental characteristics that were found to be consistently related to park-based PA were paths/trails, lighting, and

ACCEPTED MANUSCRIPT

incivilities. The causal influence of these factors on park-based PA should be a focus of future studies. On the other hand, the current review identified several mixed physical environment attributes of park-based PA, which may be due to differences in sample characteristics or methodologies. The inconsistent environmental factors included unspecified active facilities, playgrounds and skating areas, fitness stations, picnic areas, greenness, park size, park density, and park proximity. Given the unanswered questions about the associations between physical environments and park-based PA, this review provides some recommendations for future studies. First, prospective and intervention studies are of importance in order to assess any causality for the relationships between park-based PA and environmental factors. Moreover, the inconsistent findings suggest that future studies should more rigorously explore the relationship between physical environmental factors and park-

CR IP T

based PA by using standardized measures with satisfactory reliability and validity and by considering potential moderating and confounding factors. Such an approach could improve the development of a conceptual model that better describes the associations between physical environment and park-based PA. Further, future studies should pay greater attention to how the neighborhood environment facilitates park-based PA as we found that neighborhood environment attributes of park-based PA were less likely to be examined compared with park built environment. A final consideration is to evaluate the magnitude of associations via meta-analysis. Overall, this review provides a guide for future research that aims to increase park-based PA

AN US

through the modification of physical environments.

Acknowledgements

This work was supported by the Germany/Hong Kong Joint Research Scheme 2015/16 under Hong Kong SAR Governments’ RGC Grant (No. G-HKBU202/15) and the Faculty Research Grant, Hong Kong Baptist University, Hong Kong (No.FRG2/13-

M

14/065). We would like to express our sincere gratitude to Professor Ryan E. Rhodes for proofreading this paper. Authors’ Contributions

ED

RZ did the literature review, review update, and data extraction; and wrote the first draft of the manuscript; YPD, HW, and PW revised the manuscript. All authors have read and approved the final version of the manuscript, and agree with the order of

Competing Interests

PT

presentation of the authors.

AC

CE

The authors declare that they have no competing interests.

ACCEPTED MANUSCRIPT

References 1.

Giles-Corti B, Timperio A, Bull F, Pikora T. Understanding physical activity environmental correlates: increased specificity for ecological models. Exerc Sport Sci Rev. 2005; 33:175-81. doi: 10.1097/00003677-200510000-00005

2.

Sallis JF, Floyd MF, Rodríguez DA, Saelens BE. Role of built environments in physical activity, obesity, and cardiovascular disease. Circulation. 2012; 125:729– 37. doi:10.1161/CIRCULATIONAHA.110.969022

3.

Song C, Ikei H, Igarashi M, Miwa M, Takagaki M, Miyazaki Y. Physiological and psychological responses of young males during spring-time walks in urban parks. J Physiol Anthropol. 2014; 33:8. doi: 10.1186/1880-6805-33-8.

4.

Thompson Coon J, Boddy K, Stein K, Whear R, Barton J, Depledge MH. Does participating in physical activity in outdoor natural environments have a greater effect on physical and mental wellbeing than physical activity indoors? A systematic review. Environ Sci Technol. 2011; 45:1761–72. doi: 10.1021/es102947t Bai H, Wilhelm Stanis SA, Kaczynski AT, Besenyi GM. Perceptions of neighborhood park quality: associations with physical activity and body mass index. Ann Behav Med. 2013; 45 (Suppl .1):S39-48. doi:10.1007/s12160-012-9448-4

6.

Cohen DA, Marsh T, Williamson S, Derose KP, Martinez H, Setodji C, et al. Parks and physical activity: why are some parks used more than others? Prev Med. 2010; 50(Suppl. 1):S9-12. doi:10.1016/j.ypmed.2009.08.020

7.

Cohen DA, Han B, Isacoff J, Williamson S, Marsh T, McKenzie TL, et al. Impact of park renovations on park use and park-based physical activity. J Phys Act Health. 2015; 12:289–95. doi:10.1123/jpah.2013-0165

8.

Sallis JF, Cerin E, Conway TL, et al. Physical activity in relation to urban environments in 14 cities worldwide: a cross-sectional study. Lancet. 2016; 387: 2207-

AN US

17. doi: 10.1016/S0140-6736(15)01284-2 9.

CR IP T

5.

Edwards N, Hooper P, Knuiman M, Foster S, Giles-Corti B. Associations between park features and adolescent park use for physical activity. Int J Behav Nutr Phys Act. 2015; 12:21. doi:10.1186/s12966-015-0178-4

10. Kaczynski AT, Besenyi GM, Stanis SAW, Koohsari MJ, Oestman KB, Bergstrom R, et al. Are park proximity and park features related to park use and park-based physical activity among adults? Variations by multiple socio-demographic characteristics. Int J Behav Nutr Phys Act. 2014; 11:146. doi: 10.1186/s12966-0140146-4. doi:10.1186/s12966-014-0146-4

2015; 76:31–6. doi:10.1016/j.ypmed.2015.04.001

M

11. Babey SH, Tan D, Wolstein J, Diamant AL. Neighborhood, family and individual characteristics related to adolescent park-based physical activity. Prev Med.

12. Moran M, van Cauwenberg J, Hercky-Linnewiel R, Cerin E, Deforche B, Plaut P. Understanding the relationships between the physical environment and physical

ED

activity in older adults: a systematic review of qualitative studies. Int J Behav Nutr Phys Act. 2014; 11:79. doi: 10.1186/1479-5868-11-79. 13. Sallis JF, Prochaska JJ, Taylor WC. A review of correlates of physical activity of children and adolescents. Med Sci Sports Exerc. 2000; 32:963–75. doi: 10.1097/00005768-200005000-00014

14. Bancroft C, Joshi S, Rundle A, Hutson M, Chong C, Weiss CC, et al. Association of proximity and density of parks and objectively measured physical activity in

PT

the United States: A systematic review. Soc Sci Med. 2015; 138: 22–30. doi:10.1016/j.socscimed.2015.05.034 15. McCormack GR, Rock M, Toohey AM, Hignell D. Characteristics of urban parks associated with park use and physical activity: a review of qualitative research.

CE

Health Place. 2010; 16:712–26. doi:10.1016/j.healthplace.2010.03.003 16. Hunter RF, Christian H, Veitch J, Astell-Burt T, Hipp JA, Schipperijn J. The impact of interventions to promote physical activity in urban green space: a systematic review and recommendations for future research. Soc Sci Med. 2015; 124: 246–56. doi:10.1016/j.socscimed.2014.11.051

AC

17. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMAP) 2015 statement. Syst Rev. 2015; 4:1. doi: 10.1186/2046-4053-4-1. 18. Bedimo-Rung AL, Mowen AJ, Cohen DA. The significance of parks to physical activity and public health. Am J Prev Med. 2005; 28: 159–68. doi:10.1016/j.amepre.2004.10.024 19. Saelens BE, Sallis JF, Black JB, Chen D. Neighborhood-based differences in physical activity: an environment scale evaluation. Am J Public Health. 2003; 93: 1552–8. doi: 10.2105/AJPH.93.9.1552 20. Reis RS, Hino AAF, Florindo AA, Anez CRR, Domingues MR. Association between physical activity in parks and perceived environment: a study with adolescents. J Phys Act Health. 2009; 6: 503–9. doi: 10.1123/jpah.6.4.503 21. Plotnikoff RC, Costigan SA, Karunamuni N, Lubans DR. Social cognitive theories used to explain physical activity behavior in adolescents: a systematic review and meta-analysis. Prev Med. 2013; 56: 245–53. doi:10.1016/j.ypmed.2013.01.013 22. French SA, Sherwood NE, Mitchell NR, Fan Y. Park use is associated with less sedentary time among low-income parents and their preschool child: The NETWorks study. Prev Med Rep. 2017; 5: 7–12. doi: 10.1016/j.pmedr.2016.11.003

ACCEPTED MANUSCRIPT

23. Ries AV, Voorhees CC, Roche KM, Gittelsohn J, Yan AF, Astone NM. A quantitative examination of park characteristics related to park use and physical activity among urban youth. J Adolesc Health. 2009; 45(3 Suppl.): S64-70. doi:10.1016/j.jadohealth.2009.04.020 24. Spengler JO, Floyd MF, Maddock JE, Gobster PH, Suau LJ, Norman GJ. Correlates of park-based physical activity among children in diverse communities: results from an observational study in two cities. Am J Health Promot. 2011; 25: 9. doi: 10.4278/ajhp.090211-QUAN-58. 25. Rung AL, Mowen AJ, Broyles ST, Gustat J. The role of park conditions and features on park visitation and physical activity. J Phys Act Health. 2011; 8 (Suppl. 2): S178-87. doi: 10.1123/jpah.8.s2.s178 26. Dunton GF, Almanza E, Jerrett M, Wolch J, Pentz MA. Neighborhood park use by children: use of accelerometry and global positioning systems. Am J Prev Med. 2014; 46: 136–42. doi:10.1016/j.amepre.2013.10.009 27. Kaczynski AT, Potwarka LR, Saelens BE. Association of park size, distance, and features with physical activity in neighborhood parks. Am J Public Health. 2008;

CR IP T

98: 1451–6. doi:10.2105/AJPH.2007.129064 28. Kaczynski AT, Potwarka LR, Smale BJA, Havitz ME. Association of parkland proximity with neighborhood and park-based physical activity: variations by gender and age. Leisure Sci. 2009; 31: 174–91. doi:10.1080/01490400802686045

29. Floyd MF, Bocarro JN, Smith WR, Baran PK, Moore RC, Cosco NG, et al. Park-based physical activity among children and adolescents. Am J Prev Med. 2011; 41: 258–65. doi:10.1016/j.amepre.2011.04.013

30. Loukaitou-Sideris A, Sideris A. What brings children to the park?: Analysis and measurement of the variables affecting children's use of parks. J Am Plann Assoc. 2009; 76: 89–107. doi:10.1080/01944360903418338

AN US

31. Parra DC, McKenzie TL, Ribeiro IC, Ferreira Hino AA, Dreisinger M, Coniglio K, et al. Assessing physical activity in public parks in Brazil using systematic observation. Am J Public Health. 2010; 100: 1420–6. doi:10.2105/AJPH.2009.181230

32. Kaczynski AT, Koohsari MJ, Stanis SAW, Bergstrom R, Sugiyama T. Association of street connectivity and road traffic speed with park usage and park-based physical activity. Am J Health Promot. 2014; 28: 197–203. doi:10.4278/ajhp.120711-QUAN-339

33. Lackey KJ, Kaczynski AT. Correspondence of perceived vs. objective proximity to parks and their relationship to park-based physical activity. Int J Behav Nutr Phys Act. 2009; 6: 53. doi: 10.1186/1479-5868-6-53.

34. Esteban-Cornejo I, Carlson JA, Conway TL, Cain KL, Saelens BE, Frank LD, et al. Parental and adolescent perceptions of neighborhood safety related to

M

adolescents' physical activity in their neighborhood. Res Q Exerc Sport. 2016; 87: 191–9. doi: 10.1080/02701367.2016.1153779 35. Floyd MF, Taylor WC, Whitt-Glover M. Measurement of park and recreation environments that support physical activity in low-income communities of color:

ED

highlights of challenges and recommendations. Am J Prev Med. 2009; 36(4 Suppl.): S156-60. doi: 10.1016/j.amepre.2009.01.009 36. Ding D, Sallis JF, Kerr J, Lee S, Rosenberg DE. Neighborhood environment and physical activity among youth: a review. Am J Prev Med. 2011; 41: 442–55. doi: 10.1016/j.amepre.2011.06.036

37. Triguero-Mas M, Dadvand P, Cirach M, et al. Natural outdoor environments and mental and physical health: Relationships and mechanisms. Environment

PT

International. 2015; 77: 35–41. doi:10.1016/j.envint.2015.01.012

38. Van Cauwenberg J, De Bourdeaudhuij I, De Meester F, Van Dyck D, Salmon J, Clarys P, et al. Relationship between the physical environment and physical

CE

activity in older adults: a systematic review. Health Place. 2011; 17: 458–69. doi:10.1016/j.healthplace.2010.11.010 39. Van Holle V, Deforche B, Van Cauwenberg J, Goubert L, Maes L, Van de Weghe N, et al. Relationship between the physical environment and different domains of physical activity in European adults: a systematic review. BMC Public Health. 2012; 12: 807. doi: 10.1186/1471-2458-12-807.

AC

40. Cerin E, Conway TL, Adams MA, Barnett A, Cain KL, Owen N, et al. Objectively-assessed neighbourhood destination accessibility and physical activity in adults from 10 countries: an analysis of moderators and perceptions as mediators. Soc Sci Med. 2018; 211: 282-93.doi: 10.1016/j.socscimed.2018.06.034 41. Bocarro JN, Floyd MF, Smith WR, Edwards MB, Schultz CL, Baran P, et al. Social and environmental factors related to boys' and girls' park-based physical activity. Prev Chronic Dis. 2015;12: E97. doi: 10.5888/pcd12.140532. 42. Cohen DA, Han B, Derose KP, Williamson S, Marsh T, Rudick J, et al. Neighborhood poverty, park use, and park-based physical activity in a Southern California city. Soc Sci Med. 2012; 75:2317–25. doi:10.1016/j.socscimed.2012.08.036 43. Coughenour C, Coker L, Bungum TJ. Environmental and social determinants of youth physical activity intensity levels at neighborhood parks in Las Vegas, NV. J Community Health. 2014; 39:1092–6. doi:10.1007/s10900-014-9856-4 44. Edwards NJ, Giles-Corti B, Larson A, Beesley B. The effect of proximity on park and beach use and physical activity among rural adolescents. J Phys Act Health. 2014; 11: 977–84. doi: 10.1123/jpah.2011-0332 45. Kaczynski AT, Johnson AJ, Saelens BE. Neighborhood land use diversity and physical activity in adjacent parks. Health Place. 2010; 16: 413–5. doi: 10.1016/j.healthplace.2009.11.004

ACCEPTED MANUSCRIPT

46. van Dyck D, Sallis JF, Cardon G, Deforche B, Adams MA, Geremia C, et al. Associations of neighborhood characteristics with active park use: an observational study in two cities in the USA and Belgium. Int J Health Geogr. 2013; 12: 26. doi: 10.1186/1476-072X-12-26. 47. Booth ML, Okely AD, Chey TN, Bauman A. The reliability and validity of the Adolescent Physical Activity Recall Questionnaire. Med Sci Sports Exerc. 2002; 34:1986–95. doi: 10.1249/01.MSS.0000038981.35052.D3 48. Bedimo-Rung AL, Gustat J, Tompkins BJ, Rice J, Thomson J. Development of a direct observation instrument to measure environmental characteristics of parks for physical activity. J Phys Act Health. 2006; 3(Suppl. 1): S176-S189. doi: 10.1123/jpah.3.s1.s176 49. Kaczynski AT, Stanis SAW, Besenyi GM. Development and testing of a community stakeholder park audit tool. Am J Prev Med. 2012; 42: 242–9. doi: 10.1016/j.amepre.2011.10.018 50. Saelens BE, Frank LD, Auffrey C, Whitaker RC, Burdette HL, Colabianchi N. Measuring physical environments of parks and playgrounds: EAPRS instrument

CR IP T

development and inter-rater reliability. J Phys Act Health. 2006; 3(Suppl. 1): S190-S207. doi:10.1123/jpah.3.s1.s190 51. Edwards N, Hooper P, Trapp GS, Bull F, Boruff B, Giles-Corti B. Development of a public open space desktop auditing tool (POSDAT): a remote sensing approach. Appl Geogr. 2013; 38: 22–30. doi:10.1016/j.apgeog.2012.11.010

52. Walker JT, Mowen AJ, Hendricks WW, Kruger J, Morrow JR, Bricker K. Physical Activity in the Park Setting (PA-PS) Questionnaire: reliability in a California statewide sample. J Phys Act Health. 2009; 6(Suppl. 1):S97-S104. doi: 10.1123/jpah.6.s1.s97

53. Lee RE, Booth KM, Reese-Smith JY, Regan G, Howard HH. The Physical Activity Resource Assessment (PARA) instrument: evaluating features, amenities and incivilities of physical activity resources in urban neighborhoods. Int J Behav Nutr Phys Act. 2005; 2:13. doi: 10.1186/1479-5868-2-13.

AN US

54. McKenzie TL, Cohen DA, Sehgal A, Williamson S, Golinelli D. System for Observing Play and Recreation in Communities (SOPARC): reliability and feasibility measures. J Phys Act Health. 2006; 3(Suppl. 1):S208-S22.

55. McKenzie TL, Marshall SJ, Sallis JF, Conway TL. Leisure-time physical activity in school environments: an observational study using SOPLAY. Prev Med. 2000; 30:70–7. doi: 10.1123/jpah.3.s1.s208

56. Evenson KR, Sotres-Alvarez D, Herring AH, Messer L, Laraia BA, Rodríguez DA. Assessing urban and rural neighborhood characteristics using audit and GIS

AC

CE

PT

ED

M

data: derivation and reliability of constructs. Int J Behav Nutr Phys Act. 2009; 6: 44. doi: 10.1186/1479-5868-6-44.

AN US

CR IP T

ACCEPTED MANUSCRIPT

Fig.1. Flow chart of the systematic literature search. a In the 4,067 publications, 1,054 of them were identified from Ovid

AC

CE

PT

ED

M

MEDLINE, 858 were from Ovid Embase, 399 were from PsycINFO, 227 were from SPORTDiscus, and 1,529 were from Web of Science.

Table 1 The sample characteristics and methods of eligible studies Sample characteristics No. Country parks

Bai (2013)

5

Bocarro (2015) Cohen (2010)

41

6

Cohen (2012)42 Coughenour(2014)

43

Dunton (2014)26 Edwards (2014)

44

Edwards (2015)

9

Esteban-Cornejo (2016) Floyd (2011)

34

29

Age range (year)

Data types

Measures of parkbased PA

Measures of environments

SI

SI

SI

SI

SOPARC

EAPRS

US

-

3,638

51.1

12-17

CD, S

US

-

893

60.7

18-64

CD, S

US

20

-

-

-

DO

US

30

4,257

-

-

CD,DO,OA,S

SOPARC

SI

US

50

-

-

-

DO, OA

SOPARC

SOPARC

US

10

-

-

-

CD, DO, OA

SOPLAY

GIS, PARA

US

-

135

-

8-14

OA, S

Accelerometer, GPS

GIS, Gmaps, NDVI, NEWS,

AU

-

1,304

-

12-15

OA, S

APARQ

AU

58

1,304

-

12-15

OA, S

SI

GIS, NDVI, POSDAT

US

-

928

-

12-16

CD, OA, S

SI

GIS, NEWS

US

20

-

-

0-18

DO, OA

SOPARC

EAPRS

*

Aerial imagery, GIS

-

534

-

-

DO, OA, S

SI

PIN3, SI

CA

33

380

63.8

18-88

DO, OA

PA log booklet

EAPRS

Kaczynski (2009)28

CA

-

384

62.8

18-88

OA, S

PA log booklet

GIS

Kaczynski (2010)45

CA

32

384

-

18-88

DO, OA, S

PA log booklet

EAPRS, GIS, NEWS

10

US

146

893

Kaczynski (2014)32

US

Lackey (2009)31

CA

Loukaitou-Sideris (2010)30

US

Parra (2010)

20

18-98

DO, OA, S

PA-PS

CPAT, GIS

893

60.8

18-98

OA, S

PA-PS

GIS

54

574

55.4

18-88

DO, OA, S

PA log booklet

EAPRS, GIS, NEWS

100

897

-

10-13

DO, OA

SOPLAY

GIS, SOPLAY

CO

-

1,966

-

60-98

OA, S

SI

GIS

BR

-

1,718

-

14-18

S

SI

SI

AC

Reis (2009)

31

60.8

146

PT

Kaczynski (2014)

ED

US

Kaczynski (2008)27

CE

French (2016)

22

% female

AN US

Babey (2015)11

Methods No. participants

M

FiFirst author (year)

CR IP T

ACCEPTED MANUSCRIPT

16

FiFirst author (year)

Sample characteristics No. Country parks

Methods

CR IP T

ACCEPTED MANUSCRIPT

No. participants

% female

Age range (year)

Data types

Measures of parkbased PA

Measures of environments

Ries (2009)23

US

-

329

59

-

OA, S

SI

GIS, SI

Rung (2011)25

US

37

-

-

-

DO, OA, S

SOPARC

BRAT-DO, GIS

US

28

-

-

0-10

CD, DO

SOPLAY

Audit tool

BE,US

20

-

-

-

DO, OA

SOPARC

EAPRS, GIS

Spengler (2011)

24

Van Dyck (2013)

46

Note. -: not relevant; *: parent-child dyads

AN US

Country: AU: Australia, BE: Belgium, BR: Brazil, CA: Canada, CO: Colombia, US: United States of America.

Data types: CD: census data, DO: direct observation, OA: objective approach (e.g., accelerometer, Google maps), S: survey

Measures: APARQ: Adolescent Physical Activity Recall Questionnaire,47 BRAT-DO: the Bedimo-Rung Assessment Tools,48 CPAT: the Community Park Audit Tool,49 EAPRS: the Environmental Assessment for Public Recreation Spaces instrument,50 POSDAT: Public Open Space Desktop Auditing Tool,51 GIS: Geographic Information System,, Gmaps: Google maps, GPS = Global Positioning System; NDVI: Normalized Difference Vegetation Index, NEWS: Neighborhood Environment Walkability Survey, PA-PS: the Physical Activity in Park Settings questionnaire,52 PARA: the Physical Activity Resource Assessment,53 SI: the survey instrument was based on previous studies or developed by the authors, SOPARC: System for Observing Play and Recreation in Communities,54 SOPLAY: the System for Observing Play and Leisure Among Youth,55 PIN3: the Pregnancy,

AC

CE

PT

ED

M

Infection, and Nutrition (PIN3) neighborhood audit instrument,55 PA log booklet: 7-day physical activity log booklet.

17

ACCEPTED MANUSCRIPT

30

Paths/trails

5

2

Playgrounds and skating areas

6

7

Fitness stations

2

3

Swimming pools

0

5

Unspecified supporting amenities

2

5

Lighting

3

2

Picnic areas

5

5

Water features

1

Restrooms

1

(4) Crime-related safety

9, 10, 25, 27, 29, 41

0

46

?

9, 10, 25, 27

0

40

?

9, 10

0

0

0

10, 27

0

29

00

27, 29, 30, 41, 43

0

60

+

9, 20, 46

2

42

?

9, 25, 29, 41

5

0

17

0

9, 10, 27

2

0

33

0

9, 25

7

1

11

0

5, 25

2

0

60

++

5, 22, 24, 43

1

2

0

33

0

5, 30

6

5

0

55

?

9, 10, 25, 26, 27

8

8

0

50

?

9, 10, 26, 27, 28, 29, 30,46

0

4

1

0

0

9, 24

1

3

1

20

00

5, 6, 11, 30

ED

1

M

9, 10, 27

CE

Amount of shade

5, 9, 13, 27, 29, 30, 41, 42,

00 +

3

Park size

?

71

Incivilities

Greenness

25

Reference number

0

(2) Park condition Feature maintenance (3) Park aesthetics Attractiveness

0

AN US

10

Summary codes b

PT

Sport courts and fields

CR IP T

Table 2 Summary of studies that investigated associations between physical environment and park-based PA Physical environmental factors a The relationships to park-based PA, record counts +% Significantly Not statistically Significantly positive significant negative Park environment (1) Park features Unspecified active facilities 4 5 0 44

AC

Neighborhood environment

18

ACCEPTED MANUSCRIPT

The relationships to park-based PA, record counts Significantly Not statistically Significantly positive significant negative

(1) Walkability Park density

6

0

1

2

1

(2) Park proximity

6

11

0

(3) Neighborhood safety Traffic-related safety

1

4

1

0

6

Street connectivity

Crime-related safety a

Summary codes b

Reference number

45

?

10, 23, 26, 28, 31

25

0

9, 29, 30

35

?

10,11,20,23,26,27,28,33,44

17

00

20, 22, 32, 34, 43

00

22, 23, 30, 34

AN US

5

+%

CR IP T

Physical environmental factors a

1

14

Note. Factors are not be shown in the summarized tables unless three or more records were available. +%: the number of records supporting the expected association divided by total number of records. b

The criteria for summary coding of the evidence was adopted from Sallis et al. 13 +, positive association (60%–100% of records supporting the positive association); -, negative

association (60%–100% of records supporting the negative association); 0, nonsignificant association (0%–33% of records supporting the positive association); ?, inconsistent association (34%–59% of records supporting the positive association); when associations were examined in at least four studies, double signed summary codes (00, ++ or --) were

AC

CE

PT

ED

M

applied.

19

ACCEPTED MANUSCRIPT Appendix A Search strategy Ovid MEDLINE(R) 1946 to Present with Daily Update (1st December, 2016)a Physical activity in parks (park* not parkin*).mp (green adj space*). mp (green adj area*). mp (physical* activ*).mp exp*exercise/ exp*leisure activities/ energy consumption.mp energy expenditure.mp. 1 or 2 or 3 4 or 5 or 6 or 7 or 8 9 and 10

CR IP T

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.

Park environment

ED

M

AN US

(facilities or facility).mp (amenities or amenity).mp feature*.mp (court* or field*).mp playground*.mp ((playing or picnic* or seat* or eating* or rest*) adj (area* or space*)).mp (path* or trail*).mp (fitness adj (equpment or space* or area*)).mp (attract* or aesthetic*).mp (clean* or incivilit*).mp (condition or maintenance).mp (green* or vegetation or tree* or shelter*).mp (safe* or crimes).mp (program* or organiz* or supervis* staff*).mp (park adj quality).mp. (park adj size).mp 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 11 and 28

PT

12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29.

Neighborhood environment

AC

CE

30. ((neighborhood* or communit* or environment*) adj3 (characteristics or attribute* or factor* or determinant* or correlate*)).mp 31. ((physical or built or residential) adj environment*).mp 32. (street adj (connectivity or network or intersection*)).mp 33. (walkability or walkable).mp 34. (traffic adj speed).mp 35. (access* or proximity or distance*).mp 36. land-use.mp 37. (pedestrian* adj (facilit* or infrastructure* or feature*)).mp 38. (sidewalk* or pavement*).mp 39. 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37 or 38 40. 11 and 39 41. 40 or 29 a mp = title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier

ACCEPTED MANUSCRIPT

Bocarro (2015)41 Cohen (2010)6 42

Neighborhood environment (+): park proximity T

(+): incivilities A; (n.s.): feature maintenance A; attractiveness A; presence of active facilities A and crime-related safety A (+): number of active facilities F; presence of picnic areas F,M and courts M (n.s.): number of active facilities M and amenities F,M; presence of courts F

AN US

Bai (2013)5

CR IP T

Appendix B Main findings of eligible studies First author Main findings of physical environments (year) Park environment Babey (2015)11 (+): crime-related safety T

(–): crime-related safety

Cohen (2012)

(n.s.): number of active facilities

Coughenour(2014)43

(+): number of park amenities and incivilities

Dunton (2014)26

(+): presence of greenness (n.s.): park size

Floyd (2011)29 French (2016)22

ED

(+) presence of incivilities (n.s) traffic- and crime-related safety (+): park size, number of active facilities and amenities; presence of paved trails, (+): proximity to parks unpaved trails and wooded areas

AC

Kaczynski (2008)27

PT

Esteban-Cornejo (2016)34

(+) : presence of skate areas , paths and greenness; number of barbeques, picnic (n.s.): the presence of cul-de-sacs T, tables, restrooms, lighting around courts, and trees number of los T (n.s.): park size; presence of football/ cricket/ baseball/ basketball/ hockey/ rugby courts, fitness stations, and playgrounds; number of water features, seating, and active facilities; the amount of shade in paths and playground (–) crime-related safety M (n.s.) crime-related safety F; trafficrelated safety (+): number of picnic tables and courts (n.s.): sidewalk length (n.s.): number of active facilities and amenities; PA spaces size

CE

Edwards (2015)9

M

Edwards (2014)44

(–): traffic-related safety (i.e., traffic speed), sidewalk condition (+): park proximity (n.s.): park density (+): park proximity

First author (year)

Main findings of physical environments

Kaczynski (2009)28

CR IP T

ACCEPTED MANUSCRIPT

Park environment Neighborhood environment (n.s.): presence of greenness, water features, playground, football fields, tennis courts, basketball courts, swimming pools (+) park size M,F,A,E (+) park density F,A,E (n.s.) park density M; park proximity M,F,A,E

Kaczynski (2014)32 Lackey (2009)33 Loukaitou-Sideris (2010) 30

(–): land use diversity

M,A

(+):presence of basketball courts , playgrounds , trails , tennis courts , (+): park density A fitness stations F,A, skate areas A, splash pads F, and lakes A; park size F,A (n.s.): park proximity M,F,A,E; park M,E M,F, A,E M,F,A,E (n.s.): presence of playground , football fields , swimming pools , density M,F,E M,F,A,E M,A,E M,E M,F,E baseball fields , splash pads , fitness station , skate areas , basketball courts F,E, trails M,E, tennis courts M,F,E, volleyball courts M,F,A,E, greenness M,F,A,E, and lakes M,F,E; park size M E (+): street connectivity (n.s.): traffic-related safety (i.e., traffic speed) (n.s.) perceived park proximity and objective park proximity (+) number of active facilities M,F and active programs F; park attractiveness M, (n.s.): crime-related safety M,F M,F M,F M,F F (n.s.): park safety ; park size ; number of amenities , park attractiveness

PT

(+) lighting F (n.s.) lighting M

CE

Ries (2009)23

Outcome variable was “energy expenditure of park visitors”: (+):presence of basketball courts, sport fields, greenness, and playgrounds; (–):presence of benches and picnic tables;

AC

Rung (2011)25

F,A

ED

Parra (2010)31 Reis (2009)20

F,A

A

AN US

Kaczynski (2014)

10

M

Kaczynski (2010)

45

(–) street connectivity E (+) park density E; land use mix E (+) traffic-related safety M; park proximity F (n.s.) traffic-related safety F; park proximity M (+): park proximity (n.s.): park density; objectivelymeasured crime-related safety; perceived crime-related safety

ACCEPTED MANUSCRIPT

Main findings of physical environments

Spengler (2011)24

Results for Tampa: (–): amount of shade in PA areas C (n.s.): incivility C Results for Chicago: (n.s.): incivility C; amount of shade in PA areas C; Outcome variable was “number of visitors walking in parks”: (+): lighting; (n.s.): park size

Park environment Neighborhood environment (n.s.): condition of basketball courts, sport fields, greenness and playgrounds; presence of shelters, restrooms, drinking fountains and bike racks Outcome variable was “number of park visitors”: (+): presence of basketball courts, sport fields, greenness and playgrounds; condition of basketball counts (–): condition of greenness (n.s.): condition of sport fields, and playgrounds; presence of shelters, restrooms, drinking fountains, bike racks, benches, and picnic tables

AN US

Van Dyck (2013)46

CR IP T

First author (year)

M

Outcome variable was “number of visitors doing vigorous PA in parks”: (+): park size; (n.s.): lighting Note. -: not relevant

ED

Association between park-based PA and environmental factors: (+) = significantly positive; ( –) = significantly negative; (n.s.) =not significant. Italics font vs regular = perceived vs objective PA measures; bold font vs regular = perceived vs objective environmental measures; underline font vs regular = univariate vs multivariate association.

AC

CE

PT

Sample characteristics: (1) gender: M =male, F = female; (2) age: C = Children (less than 12 years), T = teens (1217 years), A = adult (1859 years), E = elderly (60+ years)

ACCEPTED MANUSCRIPT Appendix C Definition and description of physical environmental factors Physical environmental factors

Definition and description

Park environment (1) Park features Unspecified active facilities 36

Represents the factors that cannot be categorized because of lack of specificity. The presence and number of courts and fields that are built for sport activities, such as football fields and tennis courts.

Paths/trails 49,52

A trail is a special route in parks, which is especially designed for walking, running, cycling, or skating. A path is the route that is intended primarily to link different areas in a park. Paths also can be used for recreational walking, running, cycling, or skating.

Playgrounds and skating areas 49

Playground refers to a space with special equipment (such as a set of swings) designed for playing. Skating areas refers to areas designated for skateboarding. The presence and number of stations in a space that contains fitness equipment. The presence of swimming spaces.

AN US

CR IP T

Sport courts and fields 49

Fitness stations 49 Swimming pools 49

Unspecified supporting amenities Represents the factors that cannot be categorized because of lack of 36 specificity. The presence of artificial lighting (or light poles) that would allow use of this element at night.

Picnic areas 36,49

The presence and number of units in a space that is designed with tables and seating.

ED

M

Lighting 36,49

Water features 49

The presence and condition of public restrooms in parks.

AC

CE

(2) Park condition Feature maintenance 52 Incivilities 52

(3) Park aesthetics Attractiveness 30 Greenness 26 Park size30

PT

Restrooms 49

Refers to natural water areas such as lakes, rivers, and streams, not including fountains (artistic feature)

Good maintenance of park features that allows the features to be usable for physical activity (e.g., is not excessively wet or roped off for repair). Refers to visual cues of disorderly physical surroundings in parks, such as the presence and amount of broken glass, dog refuse, litter, or graffiti in parks. Refers to the aesthetics and appeal of the park environment; attractive parks include such elements as shrubs, flowers, and lush trees. The presence and density of green vegetation (such as grasses and trees) in parks. The area of parks.

ACCEPTED MANUSCRIPT Physical environmental factors Amount of shade 49

Definition and description Shade covers at least some of PA spaces in parks.

(4) Crime-related safety in parks 18

Refers to the personal security of visitors in parks. This factor was measured as the perception of crime-related safety or was objectively measured based on actual incidents of crime in parks.

Neighborhood environment (1) Walkability Park density 32 32

Number of intersections within a specific unit of land area. Refers to the distance or accessibility from home to parks.

CR IP T

Street connectivity (2) Park proximity 18 (3) Neighborhood safety Traffic-related safety 32

Number of parks within a specific unit of land area.

Refers to the level of traffic speed.

Crime-related safety 18

AC

CE

PT

ED

M

AN US

Refers to the personal security of residents in their neighborhood. This factor was measured as perceived fear or was objectively measured using actual incidents of crime in neighborhoods.

ACCEPTED MANUSCRIPT

Q4 0 1 1 0 1 1 1 1 1 1 1 0 1 1 1 1 1 0 1 0 1 1 1 0 1

Q5 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

CR IP T

Q3 0 0 1 1 1 0 1 1 0 1 1 0 1 0 0 1 1 0 1 1 1 0 1 1 1

AN US

Q2 1 1 1 0 0 0 1 1 0 0 1 0 1 1 1 1 1 1 0 0 0 0 0 0 1

M

ED

Appendix D Results of risk of bias in individual studies First author (year) Q1 11 Babey (2015) 1 5 Bai (2013) 1 41 Bocarro (2015) 1 6 Cohen (2010) 1 42 Cohen (2012) 1 43 Coughenour(2014) 1 Dunton (2014)26 1 44 Edwards (2014) 1 9 Edwards (2015) 1 34 Esteban-Cornejo (2016) 1 29 Floyd (2011) 1 22 French (2016) 1 27 Kaczynski (2008) 0 Kaczynski (2009)28 0 45 Kaczynski (2010) 0 10 Kaczynski (2014) 1 32 Kaczynski (2014) 0 33 Lackey (2009) 1 30 Loukaitou-Sideris (2010) 1 31 Parra (2010) 1 Reis (2009)20 1 23 Ries (2009) 1 25 Rung (2011) 1 24 Spengler (2011) 1 46 Van Dyck (2013) 1

Total 3 4 5 3 4 3 5 5 3 4 5 2 4 3 3 5 4 3 4 3 4 3 4 3 5

AC

CE

PT

Q1: Did the study describe the participants’ eligibility criteria? Q2: Were study samples (parks and participants) randomly selected and was the process of randomization described? Q3: Did the study report the sources and details regarding the reliability of the physical activity assessment? Q4: Did the measures of independent variables have acceptable reliability? Q5: Did the study report a power calculation and was it specifically stated as being adequately powered?

ACCEPTED MANUSCRIPT

Characteristics of studies Sample characteristics Country USA

N (%)

5, 6,10, 11, 22, 23, 24, 25, 26, 29, 30, 32, 34, 40, 41, 42, 43 9, 44 27, 28, 33, 45 20 31 46

16 (64)

24 11, 9, 20, 23, 34, 44, 5, 22 31 10, 28 6, 25, 26, 27, 29, 30, 32, 33, 41, 42, 43, 45, 46

1 (4) 6 (24) 2 (8) 1 (4) 2 (8) 13 (52)

5, 9, 10, 11, 20, 22, 23, 26, 28, 29, 30, 31, 32, 33, 34, 43, 44, 45 25, 27, 41, 42, 46 6

19 (76) 5 (20) 1 (4)

5, 11, 20 24, 25, 29, 30, 41, 42, 43, 46 6, 9, 10, 21, 23, 26, 27, 28, 31, 32, 33, 34, 44, 45

3 (12) 8 (32) 14 (56)

5, 9, 10, 11, 20, 22, 23, 24, 25, 26, 28, 29, 31, 32, 33, 34, 43, 44

18 (35)

11, 22, 26, 33, 34 10, 24, 25, 27, 31, 32, 42, 43, 44, 45, 46 5, 20, 22, 24, 29, 46 5, 10, 20, 22, 28, 32, 34 24, 25, 42, 43, 46

5 (10) 11(21) 6 (12) 7 (13) 5 (10)

5, 9, 10,11, 20, 22, 23, 27, 28, 31, 32, 33, 34, 44, 45 6, 24, 25, 26, 29, 30, 41, 42, 43, 46

15 (60) 10 (40)

5, 6, 11, 20 9,10,24,25,27, 28, 29, 30, 31, 32, 41, 42, 43, 44, 45, 46 22, 23, 26, 33, 34

4 (16) 16 (64) 5 (20)

CR IP T

Australia Canada Brazil Colombia Multiple countries Age Children (less than 12 years) Teen (12-17 years) Adult (18-59 years) Elderly (60+ years) Stratified by age Combined age Gender Stratified by gender Combined gender

References number

AN US

Appendix E Characteristics of eligible studies

CE

PT

ED

M

10, 20, 28, 30, 34, 41 6 (24) 5, 6, 9, 11, 22, 23, 24, 25, 26, 27, 29, 31, 32, 33, 42, 43, 44, 45, 19 (76) 46

Methods Unit of analyses Individual Activity areas in parks Park Data types Self-reported Objectively measured Both Covariates a Socio-demographic and social cognitive factors Family characteristics Neighborhood-level factors Behavioral factors Health situation and BMI Seasons, temperature, and the day and week types PA measures Self-reported Objectively measured Environments measures Self-reported Objectively measured Both Physical environments Park environment Neighborhood environment Both Note:a: some of the studies included two

AC

2 (8) 4 (16) 1 (4) 1 (4) 1 (4)

5, 6, 24, 25, 29, 41, 42, 46 8 (32) 22, 23, 31, 32, 33, 34, 44, 45 8 (32) 9, 10, 11, 20, 26, 27, 28, 30, 43 9 (36) or more types of covariates; column percentages may not be 100% due to

ACCEPTED MANUSCRIPT

rounding

AC

CE

PT

ED

M

AN US

CR IP T

Abbreviations: BMI = Body mass index; PA = physical activity.