posted on Monday, November 28, 2016

Outdoor scene

As we move through our 6-part series on walking and walkability this month we look at ways to support walking and walkability through programming and policy. The following recommendations were taken from STEP IT UP! The Surgeon General’s Call to Action to promote walking and walkable communities:

Promote Program and Policy Approaches that Support Walking

Policies often act as a lever to support environmental change or program implementation. Programs and policies that provide access to places for walking and encourage people to walk can improve walking and walkability. This section reviews some key program and policy approaches that support walking and walkability.

Creation of or Enhanced Access to Places for Walking with Informational Outreach

Creating or enhancing access to places for physical activity, combined with information to encourage use of these places, is a strategy recommended to increase physical activity. Examples of places for walking include public parks; health, fitness, and recreational facilities; schools, colleges, and universities; malls; senior centers; and worksites. Information that can encourage use includes advertisements, promotional messages, and signs. For example, the use of signs called “point-of-decision prompts” that display messages related to the health and weight loss benefits of exercise or point to a nearby opportunity to use the stairs has successfully increased stair walking. Places for physical activity and informational outreach are complementary efforts that together provide stronger support for physical activity.

Social Support

Social support interventions increase physical activity by providing supportive relationships for behavior change. They include actions that provide friendship and support (e.g., buddy systems, contracts with others to complete specified levels of physical activity, walking groups). The use of social support interventions in community settings is a recommended approach to increase physical activity. Consistent with this recommendation, a recent meta-analysis concluded that interventions designed to promote walking in groups increase physical activity. Recommended practices for establishing and maintaining walking groups include canvassing the community, engaging partners, organizing resources, and recruiting walking leaders.

Individually-Adapted Health Behavior Change Programs

Individually-adapted health behavior change programs teach behavioral skills that help participants incorporate physical activity into their daily routines. These programs are tailored to the specific interests, preferences, abilities, and readiness for change of the participants. They usually incorporate some form of counseling or guidance from a health professional or trainer to help participants set physical activity goals, monitor their progress toward these goals, seek social support to maintain physical activity, use self-reward and positive self-talk to reinforce progress, and use structured problem-solving to prevent relapse to an inactive or low active lifestyle. Programs can be delivered face-to-face or by the use of mail, telephone, or computer technology. The use of individually-adapted health behavior change programs is a recommended strategy to increase physical activity. A Cochrane review found that interventions that included components of individually adapted health behavior change programs had a positive effect on increasing physical activity. The Cochrane review also noted that telephone support and printed educational materials helped people initiate and increase their physical activity levels.

Community-Wide Campaigns

A community-wide campaign is a concentrated effort to promote physical activity that combines a variety of strategies, such as media coverage and promotions, risk factor screening and education, community events, and policy or environmental changes. These efforts may include several coordinated activities that, for example, set up walking groups at a worksite or school, build a new walking trail, or provide health risk appraisals and physical activity counseling at the local mall. Community-wide campaigns involve community sectors and partnerships, use communication techniques to develop their message, are large in scale, and require high-intensity efforts with sustained high visibility. According to the Community Preventive Services Task Force, community-wide campaigns can be effective in increasing physical activity and are therefore a recommended strategy. A Cochrane review that used different criteria for inclusion and exclusion of studies found that the evidence did not support the conclusion that multicomponent community-wide interventions were effective at increasing physical activity. However, the Cochrane review did find that some studies with environmental components (such as walking trails) reported positive program effects (such as observations of more people walking).

HHS (U.S. Department of Health and Human Services). 2015. Step it Up! The Surgeon General’s call to action to promote walking and walkable communities. Washington, DC:  U.S. Department of Health and Human Services, Office of the Surgeon General.