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Physical Activity: Creating or Improving Places for Physical Activity


What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 10 studies (search period 1980 – 2000).

The review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to increasing physical activity.

Summary of Results

Detailed results from the systematic review are available in the published evidence review pdf icon [PDF - 3.13 MB].

Ten studies were included in the systematic review. These multicomponent interventions were evaluated together because it was not possible to separate out the benefits of each component.

  • In all studies, creating or enhancing access to places for physical activity got people to exercise more.
    • Aerobic capacity: median increase of 5.1% (8 study arms)
    • Energy expenditure: median increase of 8.2% (3 study arms)
    • Percentage of participants reporting some leisure-time physical activity: median increase of 2.9% (4 study arms)
    • Exercise score: median increase of 13.7% (6 study arms)
  • Most of the studies also reported weight loss or decreases in body fat among program participants.

Summary of Economic Evidence

Detailed results from the systematic review are available in the published evidence review pdf icon [PDF - 3.13 MB].

Two studies were included in the economic review.

  • A 4-year study did a cost–benefit analysis of a structured physical fitness program that provided exercise classes and health seminars for employees.
    • Program benefits included savings in major medical costs, reducing the average number of disability days, and a reduction in direct disability dollar costs.
    • Program costs included personnel, non-salary operating expenses, and medical claims.
    • The adjusted estimates for benefits and costs for 1 year of the program were $1106 and $451, respectively.
  • A 5-year study with projections for an additional 10 years was conducted in a workplace setting with 36,000 employees and retirees. Researchers did a cost–benefit analysis of a company-sponsored health and fitness program that used health promotion centers, newsletters, medical reference texts, videotapes, and quarterly media blitzes.
    • Program benefits included cost savings from avoided healthcare costs, reduced absenteeism, prevented deaths, and increased productivity.
    • Program costs included personnel, overhead, capital equipment, materials, and rent. Employee time away from the job was not included as a program cost.
    • The adjusted estimates for benefits and costs were $139 million and $43 million, respectively.


Findings from this review should be applicable to diverse settings and populations provided interventions are adapted for the target population.

Evidence Gaps

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

  • What characteristics of a community are necessary for the optimal implementation of policy and environmental interventions?
  • Does the effectiveness vary by type of access (e.g., worksite facility or community facility) or socioeconomic group?
  • How can the necessary political and societal support for this type of intervention be created or increased?
  • Does creating or improving access motivate sedentary people to become more active, give those who are already active an increased opportunity to be active, or both?
  • If you build it, will they come? In other words, is enhanced access to places for activity sufficient to create higher physical activity levels, or are other intervention activities also necessary?
  • What are the effects of creating new places for physical activity versus enhancing existing facilities?
  • Which neighborhood features (e.g., sidewalks, parks, traffic flow, nearby shopping) are the most important in influencing activity patterns?
  • How does location of places such as trails or parks close to residences affect ease and frequency of use?
  • How do interventions affect various population subgroups, such as age, gender, race, or ethnicity?
  • Are there any key harms?
  • How might approaches to increase physical activity reduce potential harms (e.g., injuries or other problems associated with doing too much too fast)?
  • Can reliable and valid measures be developed to address the entire spectrum of physical activity, including light or moderate activity?
  • What is the cost-effectiveness of these interventions? What combinations of components in multicomponent interventions are most cost-effective?
  • How can effectiveness in terms of health outcomes or quality-adjusted health outcomes be better measured, estimated, or modeled?
  • How do specific characteristics of each of these approaches contribute to economic efficiency?
  • What are the physical or structural (environmental) barriers to implementing these interventions?
  • What resource (time and money) constraints slow or stop the implementation of these interventions?
  • Physical activity is difficult to measure consistently across studies and populations. Although several good measures have been developed, reliable and valid measures are needed for the spectrum of physical activity including moderate or light activity.

Study Characteristics

  • Evaluated interventions provided access to weight and aerobic fitness equipment in local fitness centers or community centers, provided access to nearby fitness centers, or created walking trails.
  • In addition to promoting access, many of the studies included components such as training to use equipment; health behavior education and techniques, seminars, counseling, risk screening, health forums, and workshops; referrals to physicians or additional services, health and fitness programs, and support or buddy systems.
  • All studies were conducted in the United States.
  • Studies were conducted at worksites, including industrial plants (automotive, brewing, printing), universities, and federal agencies (8 studies), or in low-income communities (2 studies).