The purpose of this study is to understand health care provider barriers to referring patients to Medical Fitness Center Facilities within an affiliated teaching hospital system using referral of diabetic services as an example. The aims of this study include: (1) to assess health care providers’ awareness and use of facilities, (2) to determine barriers to referring patients to facilities, (3) identify current and needed resources and/or changes to increase referral to facilities. A 20-item electronic survey and requests for semi-structured interviews were administered to hospital system directors and managers (n = 51). Directors and managers instructed physicians and staff to complete the survey and interviews as applicable. Perceived barriers, knowledge, utilization, and referral of patients to Medical Fitness Center Facilities were collected and examined. Descriptive statistics were generated regarding practice characteristics, provider characteristics, and referral. Of the health care providers surveyed and interviewed (n = 25) 40% indicated verbally suggesting use of facilities, 24% provided a flyer about the facilities. No respondents indicated that they directly referred patients to the facilities. However, 16% referred patients to other locations for physical activity - including their own department’s management and prevention services. 20% do not refer to Medical Fitness Center Facilities or any other lifestyle programs/locations. Lack of time (92%) and lack of standard guidelines and operating procedures (88%) are barriers to referral. All respondents indicated a strong ability to refer patients to Medical Fitness Center Facilities if given education about referral programs available as well as standard clinical guidelines and protocol for delivery. The results of this study indicate that, although few healthcare providers are currently referring patients to Medical Fitness Center Facilities, health care providers with an affiliated Medical Fitness Center Facility not only want clinical standard guidelines, protocol, and training to refer patients to Medical Fitness Center Facilities, but believe they have the ability to increase referral if given these tools. The Medical Fitness Association has a unique opportunity to bridge health care providers to Medical Fitness Center Facilities by developing clinical practice guidelines in cooperation with the American Diabetes Association.

Although perceptions and uses vary, nature-based health interventions (NBHIs) help facilitate the additional health benefits of physical activity (PA) experienced in nature, thereby reducing all-cause morbidity and mortality. The purpose of this mixed-methods, cross-sectional study was to better understand perceptions, terminology, and participation in NBHIs. A questionnaire was developed by reviewing validated instruments and gauging expert experience with stakeholders. Distributed electronically, a community partner listserv promoting active living served as the population. Quantitative questionnaire measures assessed familiarity with NBHI terms, concepts, experience, how NBHI should be used, and the importance of NBHI components. Qualitative themes included the strengths and weaknesses of NBHIs. Participants (n = 53) were familiar with the terms nature play (82%), forest bathing (78%), and park and nature prescriptions (74%) and moderately familiar with NBHIs (5-point Likert scale, M = 3.27, SD = 1.17). Most thought NBHIs could be useful in treating physical (96%) and mental health conditions (100%) and would follow or write one (80%). The location was reported as the most important component, followed by access, social comfort, dosage, and ongoing support. This study suggests stakeholders are familiar with and support NBHIs conceptually; however, policies, support, and funding opportunities are needed to operationalize components to increase use of NBHIs.

Physical activity (PA), associated with all-cause mortality, morbidity, and healthcare costs, improves vitamin D absorption, immune response, and stress when completed outdoors. Rural communities, which experience PA inequities, rely on trails to meet PA guidelines. However, current trail audit methods could be more efficient and accurate, which geospatial video may support. Therefore, the study purpose was (1) to identify and adopt validated instruments for trail audit evaluations using geospatial video and a composite score and (2) to determine if geospatial video and a composite score motivate (influence the decision to use) specific trail selection among current trail users. Phase 1 used a mixed-method exploratory sequential core design using qualitative data, then quantitative data for the development of the Spatial-temporal Trail Audit Tool (STAT). Geospatial videos of two Northeast Ohio trails were collected using a bicycle-mounted spatial video camera and video analysis software. The creation of STAT was integrated from Neighborhood Environment Walkability Scale (NEWS), Walk Score, and Path Environment Audit Tool (PEAT) audit tools based on four constructs: trail accessibility, conditions, amenities, and safety. Scoring was determined by three independent reviewers. Phase 2 included a mixed-method convergent core design to test the applicability of STAT for trail participant motivation. STAT has 20 items in 4 content areas computing a composite score and was found to increase trail quality and motivation for use. STAT can evaluate trails for PA using geospatial video and a composite score which may spur PA through increased motivation to select and use trails.

Introduction. The purpose of this paper is to describe development and preliminary assessment of an instrument designed to assess facilitators and barriers of provider-provided, place-based exercise prescriptions, including provider attributes, perceptions, knowledge, and resource needs. Although the American Medical Association-Supported “Exercise is Medicine” initiative encourages the practice of exercise prescription among member providers, only a small proportion engages in this practice. Additionally, little is known about the role of place-based exercise prescriptions, although access to physical activity resources differs based on residence, access to transportation, income, and other factors. To utilize potential for prescriptions to encourage physical activity, better understanding of the role of place is essential. Methods. Previously validated and newly developed items were combined to create an 88-item survey that was administered to 166 healthcare providers. Results. Results of principal components analysis suggested a five-factor structure; three factors—provider belief in exercise benefits, provider training needs, and place-based concerns—demonstrated high internal consistency. Factors demonstrating low internal consistency included provider attitudes about their role in exercise prescription and providers’ perceptions of patient barriers. Conclusions. Following this stage in survey validation, the 88-item developed survey could be shortened by eliminating items with low loadings. Providers may be more receptive to a shorter instrument, which could facilitate reliability and validity testing of a revised instrument. Further steps to validate the instrument include assessing consistent responses over time and considering predictive ability of the survey as an additional measure of validity. Results from the initial survey administration indicate that providers’ lack of training regarding how to prescribe exercise and lack of knowledge of safe, affordable, or proximate locations for patients to engage in prescribed exercise present barriers to wider use of exercise prescriptions. Community-clinical linkages which network providers with area physical activity and exercise resources may present a partial solution. Knowledge of safe, affordable, or proximate locations for patients to engage in prescribed exercise presents a barrier to place-based exercise prescriptions.

Context & Objective: Written a decade ago, the 2015 Rural Active Living: A Call to Action (published in 2016) described rural-specific efforts in the fields of active living and physical activity (PA) and identified 8 recommendations to guide rural active living research and practice. Given that rural populations continue to experience a higher burden of PA-related chronic health conditions, the objective of this review was to revisit the 8 Rural Active Living Calls to Action, reassess the evidence base, summarize advances in each area, and identify emerging areas that warrant examination or further study. Methods: We leveraged expertise from researchers and practitioners within the CDC-funded Physical Activity Policy Research and Evaluation Network Rural Active Living Workgroup and reviewed literature published since the original call to action. Teams were formed for each of the original 8 calls to action. Each team reviewed the literature, synthesized findings, and developed recommendations for future research. Results: Academic and practice-based progress was evident across multiple of the original calls to action. Despite these findings, the need persists for rural-specific national surveillance data scaled to small geographies (census tract and block group) that accounts for differences within and across rural communities, various forms of rural governance, and how these factors interplay with active living opportunities. Six emerging areas of research (best practices, social issues, COVID-19 effects, collaboration, implementation science, and implications of rural health-related funding changes) are discussed and warrant further study. Conclusions: In summarizing progress since the original Call to Action, we recommend strategies to continue advancing rural active living and identify emerging focus areas.

Parent modeling of physical activity (PA) can predict child PA with engagement and logistical support. The purpose of this study was to (1) determine changes in family PA and (2) if parents meeting PA guidelines (PAG), including active transport to school (ATS), increases odds of children meeting PAG before and during the pandemic. Guided by the Parent Engagement and Support, PA, and Academic Performance theoretical model (PESPAAP), validated measures of retrospective self-reported parent and child PA from before and during the pandemic were requested in a Safe Routes to School survey emailed to kindergarten – eighth grade parents via a Qualtrics link. Due to model fit, Wilcoxon signed rank test, Fisher’s exact correlations, and logistic regression were conducted using SPSS. Parents reported significantly more PA (N = 451) during (Mdn= 60, SD) compared to before the pandemic (Mdn = 30), z = -2.04, p = .041. Similarly, parents reported children’s PA was significantly higher during (Mdn = 255.00) compared to before the pandemic (Mdn = 240.00), z = -2.70, p = .007. Fisher’s exact test (p = < 001) indicated a significant association between parents and children meeting physical activity guidelines (PAG) as parents meeting PAG was associated with children meeting PAG before (OR = 10.5, 95% CI [6.620, 16.956], p < 0.001) and during (OR = 6.6, 95% CI [4.187, 10.404], p < 0.001) the pandemic. Understanding these relationships, reasons for increase in PA during the pandemic, and how to use the PESPAAP theoretical model may assist in the success of post pandemic family PA health behavior interventions by focusing on child PA, parent support, and parent engagement.