To reverse the global epidemic of physical inactivity that is responsible for more than 5 million deaths per year, many groups recommend creating “activity-friendly environments.” Such environments may have other benefits, beyond facilitating physical activity, but these potential co-benefits have not been well described. The purpose of the present paper is to explore a wide range of literature and conduct an initial summary of evidence on co-benefits of activity-friendly environments. An extensive but non-systematic review of scientific and “gray” literature was conducted. Five physical activity settings were defined: parks/open space/trails, urban design, transportation, schools, and workplaces/buildings. Several evidence-based activity-friendly features were identified for each setting. Six potential outcomes/co-benefits were searched: physical health, mental health, social benefits, safety/injury prevention, environmental sustainability, and economics. A total of 418 higher-quality findings were summarized. The overall summary indicated 22 of 30 setting by outcome combinations showed “strong” evidence of co-benefits. Each setting had strong evidence of at least three co-benefits, with only one occurrence of a net negative effect. All settings showed the potential to contribute to environmental sustainability and economic benefits. Specific environmental features with the strongest evidence of multiple co-benefits were park proximity, mixed land use, trees/greenery, accessibility and street connectivity, building design, and workplace physical activity policies/programs. The exploration revealed substantial evidence that designing community environments that make physical activity attractive and convenient is likely to produce additional important benefits. The extent of the evidence justifies systematic reviews and additional research to fill gaps.

This review sought to investigate the question: what are the key barriers to, and enablers for, older adults undertaking muscle strengthening and balance activities, and how can these be addressed by individuals and practitioners? A search of PubMed for review-level evidence on professional and personal barriers and motivators for strength and balance activities among older people. The search and expert consultation found 46 studies; after screening, twelve papers were included. Many of the barriers and motivators to strength and balance activities are familiar ones that can also apply to physical activity more generally, such as not having the time. More specific barriers to strength and balance activities for older people were perceived risk of a heart attack, stroke, or death, and fear of looking too muscular; with motivators being improved ability to complete daily activities, preventing deterioration and disability, and decreasing the risk or fear of falling. This review of reviews has found a small but consistent body of literature describing the motivators and barriers to older adults taking part in strength and balance activities. This may be used as the basis for planning and delivering physical activity programmes for older adults.

Background: There is growing interest in conceptualising public health problems such as physical inactivity as the outcome of multiple interacting factors within complex systems. A systems approach includes consideration of the indirect as well as direct impacts of interventions, the contexts within which they take place, the relations between the multiple factors at play, and the ways in which systems adapt in response to changes. This study involved working with stakeholders involved in a city-wide physical activity promotion programme in Derby, UK to investigate whether a conceptual map of the local physical activity system could be a useful tool to help improve the planning and implementation of the programme. Methods: We produced draft conceptual maps of the major modifiable drivers of physical activity in the city, based on the existing literature on determinants and correlates of physical activity, then refined them in a series of stakeholder meetings. The maps were used to explore ways in which the existing programme took a systems approach, and how it might be enhanced. Semistructured interviews were subsequently undertaken with stakeholders to assess their views on the contribution of the mapping approach. Results: Feedback from stakeholders described the mapping as valuable, especially in helping to identify the limitations of the original approach taken in the city. Conclusions: Even a very simple application of systems thinking can be a useful tool for disaggregating the key factors driving a system, helping to identify areas that merit greater attention, and supporting effective action.

The World Health Organization’s Health Economic Assessment Tool (HEAT) for walking and cycling is a user-friendly web-based tool to assess the health impacts of active travel. HEAT, developed over 10 years ago, has been used by researchers, planners and policymakers alike in appraisals of walking and cycling policies at both national and more local scales. HEAT has undergone regular upgrades adopting the latest scientific evidence. This article presents the most recent upgrades of the tool. The health impacts of walking and/or cycling in a specified population are quantified in terms of premature deaths avoided (or caused). In addition to the calculation of benefits derived from physical activity, HEAT was recently expanded to include assessments of the burden associated with air pollution exposure and crash risks while walking or cycling. Further, the impacts on carbon emissions from mode shifts to active travel modes can now be assessed. The monetization of impacts using Value of Statistical Life and Social Costs of Carbon now uses country-specific values. As active travel inherently results in often substantial health benefits as well as not always negligible risks, assessments of active travel behavior or policies are incomplete without considering health implications. The recent developments of HEAT make it easier than ever to obtain ballpark estimates of health impacts and carbon emissions related to walking and cycling.

Evidence-based public health takes many of the principles of evidence-based medicine and applies them to public health. This is a relatively young discipline however and is not universally applied to public health issues - especially such multi-disciplinary topics as physical activity. This paper sets out to provide guidance on this issue by characterising four 'key tasks' that form the basis of a systematic evidence-based approach to promoting physical activity. These tasks are based in part on the physical activity promotion model (Brownson et a1.,1999). These are illustrated with examples from work in three contrasting European countries: Finland, England and Switzerland. 'Task one' is concerned with using the evidence for the health benefits of physical activity to 'make the case' and increase action by policy makers. Here, all three countries took a similar approach, conducting academic reviews to draw together the existing evidence of the health benefits of physical activity. 'Task two' is concerned with conducting surveillance to collect evidence on the prevalence of physical activity. Here, Finland and Switzerland were careful to collect trend data and use them for advocacy, while in England continuous changes to questionnaires and survey methodologies have led to poor trend data. 'Task three' is to review evidence on 'what works' in increasing physical activity to influence practice. England appears to be taking a more systematic approach to this task, with a comprehensive approach to reviewing evidence on what works and disseminating this to influence good practice, while the other countries rely mainly on individual evaluation studies. 'Task four' is the evaluation of practice and it is clear that in all three countries this remains a significant challenge - one requiring additional training and dedicated funding. As a result much of current "good practice" is based upon experience (usually unevaluated) and not evidence. This brief analysis shows that there are some common tasks that need to be undertaken as a central part of an evidence-based public health approach. However, cultural and political factors in each country studied have influenced the manner in which these tasks were undertaken, and the importance attached to each component.

Promoting walking for transport may help to increase physical activity levels. Associations between the built environment and walking for transport have been well reported. Engaging communities in making small-scale changes to local routes is one potential low-cost strategy to improve neighbourhood environments. The purpose of this study was to evaluate changes in pedestrian use of local routes following environmental changes made by communities and local authorities (LAs) in the ‘Fitter for Walking’ (FFW) project, to assess route users’ awareness of the environmental improvements which were implemented and to make recommendations for future evaluation. FFW targeted deprived communities in twelve LA areas in England. Coordinators worked with communities and LA partners to improve local route environments based on identified barriers to walking. Route user counts and intercept surveys were conducted in five FFW case studies at baseline, 12 months and 14–20 months after the project activities had commenced. A wide range of environmental improvements were undertaken. After 12 months, there was a decrease in pedestrian route use overall (−19.4%) and in four case studies (range −42.1% to −10.4%). However, after 14–20 months, an increase in pedestrian route user overall (14.9%) and in all case studies (range 5.4–58.9%) was observed compared to baseline. Route users’ awareness of environmental improvements made to routes varied across case studies and was very low for some of the improvements which had been made. Engaging communities in making small-scale environmental improvements to key routes in local neighbourhoods may be an effective, low-cost strategy for increasing walking for transport. Increasing the number of people walking on newly improved routes may take a long time and require additional promotional initiatives. Evaluating these types of initiatives is challenging. These factors should be considered by health and transport professionals developing initiatives and by researchers interested in measuring behaviour change.