Community supports for physical activity: Why and how to keep track of them

Photos of Jim Sallis and Daniel RodriguezJames F. Sallis, Ph.D., Department of Family Medicine and Public Health, University of California San Diego; Daniel A. Rodriguez, Ph.D., Department of City & Regional Planning and Institute for Transportation Studies, University of California, Berkeley

Background: Physical activity is a key determinant of health and well-being and a major protective factor for cardiovascular diseases. Public health action to improve physical activity in the population depends on having good data, which is why the National Academies of Sciences, Engineering, and Medicine issued a report, Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States, in May 2019. Laurie Whitsel, PhD, provided an overview of the report in a prior Center for Health Metrics and Evaluation commentary.

A useful surveillance system for public health planning must go beyond assessing only physical activity by including measures of modifiable characteristics that can influence the behavior. This system can also reflect the extent of interventions and changes in those characteristics nationwide. In this post, as members of the report committee, we summarize some key messages from the chapter on “Community Supports for Physical Activity.”

What are “community supports”? We, the committee, defined them as infrastructure (for example, sidewalks and parks), neighborhood design characteristics (for example, the mixture of land uses), policies (for example, traffic calming and encouraging compact development), and programs directly relevant to physical activity.

Why should community supports be measured as part of physical activity surveillance? Though community supports may not be traditional elements of surveillance systems, they represent opportunities, facilitators and barriers to people being active for both recreation and transportation purposes. Community environments, policies and programs that are favorable to physical activity are featured in evidence-based recommendations, such as Healthy People 2020, The Community Guide and the Surgeon General’s Call to Action to Promote Walking and Walkable Communities.

Periodic tracking of these diverse community influences can inform public health professionals whether progress is being made in creating more supportive conditions for physical activity. Inequities across race, ethnic and income groups in access to community supports have been documented. Monitoring of these influences can be used to identify the inequities, motivate action and document whether and where progress to address the disparities is being made.

Highlights of the report’s recommendations on community supports for physical activity include:

  • Develop consensus on:
    • Survey questions about neighborhood characteristics that can be included in existing surveillance systems (Strategy 17), and
    • Observational (audit) methods to reliably assess the presence and condition of these neighborhood characteristics (Strategy 21).
  • Use existing Geographic Information Systems data documenting community supports and encourage local, regional, state, and federal agencies to update these data periodically so trends can be monitored (Strategy 18).
  • Partner with diverse professional organizations to survey their members about physical activity-relevant policies in the communities where they work. Supports for physical activity are usually the domain of city planning, transportation engineering, public works and parks and recreation agencies, so these professionals outside the health field are most knowledgeable about the policies. (Strategy 19).
  • Validate instruments to assess availability of physical activity programs and promotional resources. Because such measures are not available, this was identified as a research need (Strategy 22).

Cutting across these strategies is the need for local health departments to adopt the same measures for identifying local needs and patterns of disparities, then using the data to guide local actions.

Another important recurring theme in the report was that community supports are the responsibility of sectors and agencies outside of public health and health care, so health agencies need to develop effective partnerships with relevant government agencies and professional organizations to implement many of the surveillance recommendations.

Heart disease and stroke patients live in the same neighborhoods as healthy people, so health care providers have a stake in the quality of community supports. We encourage health care providers to become educated about community supports and become advocates for more physical activity-supportive environments.