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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Physical Activity.

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Strategy. Infrastructure and Environmental Supports for Physical Activity

Approach. Promote the development and use of infrastructure that facilitates physical activity (e.g., walking trails, sidewalks, playgrounds, parks)

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Overview. Environmental strategies focusing on increasing physical activity have been shown to be effective, especially when increasing physical activity among school-aged boys.[1,2] These strategies may include the creation of walking trails and other physical activity infrastructure through legislative, fiscal, or policy requirements.[3] Additionally, promotion of new or existing facilities is critical to encourage use.[1]

Evidence. Moderate Evidence. Strategies based on moderate evidence show a clear trend toward positive results. While these approaches are likely to be effective, further research is needed to confirm their impact. Implement with evaluation to better understand specific local effects.

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Policy tracking records
  • Community partnerships and project collaboration agreements
  • Community perception surveys

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Environmental Health. This strategy improves the impact of physical, chemical, and biological factors in the environment on health.
  • Health and Health Behaviors/Behavior Change. This strategy improves individuals' physical and mental health and their adoption of healthy behaviors (e.g., healthy eating, physical activity).

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Community Organizing (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy or aligned components.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of new walking trails, sidewalks, and playgrounds constructed that are supported by Title V. (Assesses increase in physical activity infrastructure)
  • Number of community input sessions held to guide infrastructure development. (Measures planning process)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of new walking trails, sidewalks, and playgrounds constructed that are supported by Title V. (Assesses increase in physical activity infrastructure)
  • Percent of community input sessions held to guide infrastructure development. (Measures planning process)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of local policies supported by Title V updated to support ongoing maintenance of physical activity infrastructure. (Shows policy-level changes)
  • Number of residents reporting improved perception of neighborhood walkability and recreation opportunities following implementation of infrastructure development. (Assesses changes in community attitudes)
  • Number of additional hours of outdoor physical activity reported by residents near new infrastructure implemented by Title V. (Quantifies behavior change)
  • Number of car trips replaced by walking for biking due to improved infrastructure implemented by Title V. (Assesses impact on active transportation)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent of local policies supported by Title V updated to support ongoing maintenance of physical activity infrastructure. (Shows policy-level changes)
  • Percent of residents reporting improved perception of neighborhood walkability and recreation opportunities following implementation of infrastructure development. (Assesses changes in community attitudes)
  • Percent of additional hours of outdoor physical activity reported by residents near new infrastructure implemented by Title V. (Quantifies behavior change)
  • Percent of car trips replaced by walking for biking due to improved infrastructure implemented by Title V. (Assesses impact on active transportation)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

1 Nordbø, E. C. A., Nordh, H., Raanaas, R. K., & Aamodt, G. (2019). Promoting activity participation and well-being among children and adolescents: a systematic review of neighborhood built-environment determinants. JBI database of systematic reviews and implementation reports.

2 Sallis, J. F., McKenzie, T. L., Conway, T. L., Elder, J. P., Prochaska, J. J., Brown, M., ... & Alcaraz, J. E. (2003). Environmental interventions for eating and physical activity: a randomized controlled trial in middle schools. American Journal of Preventive Medicine, 24(3), 209-217.

3 Piercy, K.L., Dorn, J.M., Fulton, J.E., et al. (2015) Opportunity for public health to increase physical activity among youths. American Journal of Public Health, 105(3), 421-426.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.