STEP IT UP!

THE SURGEON GENERAL’S CALL TO ACTION 

TO PROMOTE WALKING 

AND WALKABLE COMMUNITIES

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

U.S. Public Health Service

Office of the Surgeon General

Suggested Citation

U.S. Department of Health and Human Services. Step It Up! The Surgeon General’s Call to Action to Promote 

Walking and Walkable Communities. Washington, DC: U.S. Dept of Health and Human Services, Office of the 

Surgeon General; 2015. 

This publication is available at www.surgeongeneral.gov.

Website addresses of nonfederal organizations are provided solely as a service to our readers. Provision of 

an address does not constitute an endorsement by the U.S. Department of Health and Human Services (HHS) 

or the federal government, and none should be inferred. HHS is not responsible for the content of other 

organizations’ web pages.
STEP IT UP!

THE SURGEON GENERAL’S CALL TO ACTION 

TO PROMOTE WALKING 

AND WALKABLE COMMUNITIES
ii
iii

Message from the Secretary, 

U.S. Department of Health and Human Services

Being physically active is one of the most important steps that Americans 

of all ages can take to improve their health. But only half of adults and 

about a quarter of high school students get the amount of physical activity 

recommended in national guidelines. Step It Up! The Surgeon General’s Call to 

Action to Promote Walking and Walkable Communities aims to get Americans 

walking and wheelchair rolling for the physical activity needed to help prevent 

and reduce their risk of chronic diseases and premature death. And it supports 

positive mental health and healthy aging as well.

From the time we take our first steps as children, walking becomes such an 

important part of our lives that we often take it for granted. As a way to enjoy 

nature, get the blood moving, or just get from one point to another, for many 

people, walking is an easy and free way to explore the world. 

But for some, access to safe places to walk isn’t so simple. Without well-connected sidewalks and paths, or 

nearby destinations, our daily decision to walk or roll can be a bit tough. And that is especially true for people 

who need to use assistive devices or wheelchairs. 

That is why this Call to Action is so important. 

The Call to Action provides strategies that communities can use to support walking, which we hope will result 

in long-lasting changes to improve the health and health care of Americans today and of the generations that 

follow. The Call to Action adds to our work to educate, empower, and engage Americans to take control of 

their health, including initiatives like the National Prevention Strategy: America’s Plan for Better Health and 

Wellness, the National Physical Activity Plan, Healthy People 2020, and the Healthy Self campaign. 

Like all parents, I am looking for easy, fun ways to keep my family healthy. Walking is an important option, 

and I believe all Americans want that choice. We need access to safe and convenient places to walk and 

wheelchair roll and a culture that supports activity where we live, learn, work, and play. As Secretary of 

Health and Human Services, I urge all areas of society—transportation, community design, education, 

business, nonprofits, parks and recreation, health care, public health, and the media—to help make our 

communities more walkable, so that walking is an easy choice for Americans to improve their health. 

Sylvia Mathews Burwell

Secretary

U.S. Department of Health and Human Services
iv
v

Foreword from the Surgeon General,

U.S. Department of Health and Human Services

There are many reasons to take a walk. We may walk to school, to work, or even 

to our places of worship. We may walk to help us think better and relieve stress. 

Often, we may take a stroll in order to spend quality time with the people and 

the pets we love most. And, throughout history, we’ve walked and marched in 

order to make our voices heard and our presence felt. As your Surgeon General, 

I celebrate all the many reasons for walking—and wheelchair rolling. Carving out 

just 22 minutes a day on average or 2 1⁄2 hours a week for physical activity, like 

brisk walking, can do wonders for your overall health.

That is why I am proud to release Step It Up! The Surgeon General’s Call to 

Action to Promote Walking and Walkable Communities. This Call to Action

reflects my deep commitment to several key principles for improving the health 

of our great nation. 

First, the Call to Action focuses on promoting optimal health before disease occurs. As Americans, we lead the 

world in treating disease. As America’s Doctor, I believe we must also lead the world in preventing disease. 

Robust scientific evidence shows that physical activity is critical for both preventing and treating many of the 

chronic conditions we face today. Being physically active is one of the most important ways to improve health 

and well-being throughout our lives. 

Second, the Call to Action is applicable to the health of people at all ages and stages of life. Walking is the 

most common activity of teens and adults. It requires no specialized skills or equipment and is a great first 

step (pun intended) for anyone who has been inactive. Taking a walk with family or friends can help our 

emotional well-being and connect us to our communities. And because active older adults are less likely to 

suffer from falls, walking is a great way to help us enjoy a good quality of life and live independently for years 

to come. 

Third, the Call to Action recognizes that everyone should have access to spaces and places that make it safe 

and easy for us to walk or wheelchair roll—whether in urban, suburban, or rural settings. This means that 

the people who design our cities and neighborhoods should include well-maintained sidewalks, pedestrianfriendly streets, access to public transit, adequate lighting, and desirable destinations that are close to home. 

It also means that law enforcement and community leaders should work closely together to ensure that none 

of us has to walk in fear for our safety. Walkable communities are good for social connectedness, good for 

business, good for the environment, and, most importantly, good for our personal health. 

My goal for this Call to Action is for each one of us to recognize and embrace our role in building the great 

American community, a place where being physically active is not only easier but also more engaging and 

fun. Find ways to make walking a part of your daily routine and invite friends, family, and colleagues to join 

you. Make your voice heard in decisions that affect how your city or town is planned. And support efforts to 
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build more sidewalks, hiking trails, and public parks. Finally, I encourage you to partner with institutions and 

organizations that have already embraced this vision in your communities. You can learn more about some of 

these institutions and organizations on our website at www.surgeongeneral.gov. 

Walking for better health may seem simplistic, but sometimes the most important things we can do are also 

the easiest and the most obvious. It’s time to step it up, America! The journey to better health begins with a 

single step.

Vivek H. Murthy, M.D., M.B.A.

Vice Admiral, U.S. Public Health Service

Surgeon General

U.S. Department of Health and Human Services
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Contents

Message from the Secretary, U.S. Department of Health and Human Services .............. iii

Foreword from the Surgeon General, U.S. Department of Health and Human Services . . . . . . . . v

Promoting Walking and Walkable Communities: A Strategy to Improve Health . . . . . . . . . . . . . . 1

Physical Activity: An Essential Ingredient for Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Chronic Diseases in the United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Benefits of Physical Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Physical Activity Guidelines for Americans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Physical Activity in the United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Why Focus on Walking as a Public Health Strategy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Walking Is an Easy Way to Start and Maintain a Physically Active Lifestyle . . . . . . . . . . . . . . . . . . 9

Walking Is a Common Form of Physical Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Walking Is Multipurpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Walking Benefits Communities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Makes Communities Safer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Supports Social Cohesion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Reduces Air Pollution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Benefits Local Economies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Why Don’t People Walk More? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Not Enough Time to Walk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Safety Concerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Community Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Disability, Chronic Conditions, and Aging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

How to Increase Walking and Improve Walkability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Design Communities and Streets that Support Walking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Promote Program and Policy Approaches that Support Walking . . . . . . . . . . . . . . . . . . . . . . . . . 17

Creation of or Enhanced Access to Places for Walking with Informational Outreach . . . . . . 17

Social Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
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Individually-Adapted Health Behavior Change Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Community-Wide Campaigns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

What Sectors Are Needed to Help Implement Community Approaches? . . . . . . . . . . . . . . . . . . 18

Transportation, Land Use, and Community Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Parks and Recreational and Fitness Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Schools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Colleges and Universities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Worksites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Volunteer and Nonprofit Organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Public Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Gaps in Surveillance, Research, and Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Surveillance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Walking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Walkability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Economic Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

The Call to Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Goal 1. Make Walking a National Priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Strategy 1A. Encourage people to promote walking and make

their communities more walkable. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Strategy 1B. Create a walking movement to make walking and 

walkability a national priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Goal 2. Design Communities that Make It Safe and Easy to Walk for People 

of All Ages and Abilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Strategy 2A. Design and maintain streets and sidewalks so that

walking is safe and easy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Strategy 2B. Design communities that support safe and easy places 

for people to walk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
ix

Goal 3. Promote Programs and Policies to Support Walking Where People Live, 

Learn, Work, and Play . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Strategy 3A. Promote programs and policies that make it easy for students 

to walk before, during, and after school. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Strategy 3B. Promote worksite programs and policies that support 

walking and walkability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Strategy 3C. Promote community programs and policies that make it safe 

and easy for residents to walk. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Goal 4. Provide Information to Encourage Walking and Improve Walkability . . . . . . . . . . . . . . 39

Strategy 4A. Educate people about the benefits of safe walking and 

places to walk. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Strategy 4B. Develop effective and consistent messages and engage 

the media to promote walking and walkability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Strategy 4C. Educate relevant professionals on how to promote walking 

and walkability through their profession. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Goal 5. Fill Surveillance, Research, and Evaluation Gaps Related 

to Walking and Walkability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Strategy 5A. Improve the quality and consistency of surveillance data 

collected about walking and walkability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Strategy 5B. Address research gaps to promote walking and walkability. . . . . . . . . . . . . . . . 44

Strategy 5C. Evaluate community interventions to promote walking and walkability . . . . . 45

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
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1

Promoting Walking and Walkable

Communities: A Strategy to Improve Health

One out of every two U.S. adults is living with a chronic disease, such as heart disease, cancer, or diabetes.1

These diseases contribute to disability and premature death.2

 In addition, the medical treatment of chronic 

diseases incurs substantial costs for individuals, families, and the nation.3

The good news is that many chronic diseases can be delayed, prevented, or managed through healthy 

behaviors. Along with eating a healthy diet4

 and avoiding tobacco use,5 people can decrease their risk of 

chronic disease by being physically active.6,7 Physical activity can help people with chronic diseases manage 

their conditions.7,8 In addition, physical activity reduces the risk of premature death and supports positive 

mental health and healthy aging—making it one of the most important actions people can take to improve 

their overall health.6

 To obtain substantial health benefits, the 2008 Physical Activity Guidelines for Americans

recommends that adults get at least 150 minutes of moderate-intensity aerobic physical activity or 75 

minutes of vigorous-intensity physical activity, or an equivalent combination, each week and that children and 

adolescents be active for at least 60 minutes every day.6

Despite the many benefits of physical activity, only one-half of all U.S. adults and about one-quarter of high 

school students meet the guideline for aerobic physical activity in the 2008 Physical Activity Guidelines for 

Americans.

9,10 Walking is an excellent way for most people to increase their physical activity. It is a powerful 

public health strategy for the following reasons: 

■ Walking is an easy way to start and maintain a physically active lifestyle.

■ Walking is the most common form of physical activity for people across the country.

■ Walking can serve many purposes. It can be a way to exercise, have fun, or get to school, work, or 

other nearby destinations.

■ Making walking easier can help communities by improving safety, social cohesion, and local economies 

and reducing air pollution.

To promote walking, community strategies can be implemented where people live, learn, work, and play. 

Places for walking can be designed and enhanced to improve their walkability. Improving walkability means 

that communities are created or enhanced to make it safe and easy to walk and that pedestrian activity is 

encouraged for all people.11 Improving the walkability of communities can benefit people of all abilities, 

including those who run, bike, skate, or use wheelchairs. This publication, Step It Up! The Surgeon General’s 

Call to Action to Promote Walking and Walkable Communities, is intended to increase walking across the 

United States by calling for improved access to safe and convenient places to walk and wheelchair roll, as well 

as for a culture that supports these activities for people of all ages and abilities.

This Call to Action presents five goals and supporting implementation strategies that are grounded in 

scientific and practice-based evidence. These goals call for action by multiple sectors of society, including 

transportation, land use, and community design; parks, recreation, and fitness; education (schools, colleges, 

and universities); business and industry; volunteer and nonprofit; health care; media; and public health. 

Families and individuals will also need to be involved to achieve these goals.
2

This Call to Action complements existing recommendations to help Americans become more physically active, 

such as those found in the National Prevention Strategy: America’s Plan for Better Health and Wellness12 and 

the Solving the Problem of Childhood Obesity Within a Generation: White House Task Force on Childhood 

Obesity Report to the President,13 as well as the national health objectives for physical activity in Healthy 

People 2020.14 It also aligns with the goals of initiatives such as Let’s Move!,

15 the Go4Life Campaign,16 the 

U.S. Department of Transportation’s Safer People, Safer Streets Initiative,17 the America’s Great Outdoors 

Initiative,18 and the Partnership for Sustainable Communities.19

In addition, this Call to Action builds on the National Physical Activity Plan,

20 which was developed by public 

and private partners to provide a comprehensive set of policies, programs, and initiatives that can help 

all people become more physically active and meet the 2008 Physical Activity Guidelines for Americans. 

It also reflects comments received in response to a request for information (78 FR 19491) published in 

the Federal Register on April 1, 2013. More than 750 comments were received from the public, state and 

local governments, nonprofit organizations, and professional organizations. All comments were carefully 

considered in the preparation of this Call to Action.

The first section of this publication introduces the Call to Action. The second section provides information 

about the prevalence and costs of chronic diseases in the United States and why being physically active is 

one of the most important steps people can take to decrease their risk of chronic diseases and improve their 

overall health. It also summarizes the 2008 Physical Activity Guidelines for Americans and current physical 

activity levels in the United States. The third section explains why walking is a relevant public health strategy 

for improving physical activity levels. The fourth section describes barriers to walking. The fifth section shares 

what communities can do to support walking. The sixth section examines the major gaps in surveillance, 

research, and evaluation related to walking and walkability. The final section identifies specific goals and 

strategies to promote walking and walkability in the United States and calls for nationwide action. 
3

Physical Activity: 

An Essential Ingredient for Health

Being physically active is one of the most important steps that people of all ages and abilities can take to 

improve their health.6 We know that increasing people’s physical activity levels will significantly reduce 

their risk of chronic diseases and premature death and support positive mental health and healthy aging.6,7

Increased physical activity can help children and adolescents; young, middle-aged, and older adults; 

women and men; people of different races and ethnicities; and people with disabilities and chronic health 

conditions.6,7

This section provides a brief review of the prevalence and costs of chronic diseases in the United States and 

the well-established benefits of physical activity. This section also summarizes the 2008 Physical Activity 

Guidelines for Americans and documents the current levels of physical activity in the United States.

Chronic Diseases in the United States

Chronic diseases are the leading causes of death in the United States and major contributors to years lived 

with a disability.2

 In 2012, almost 50% of U.S. adults, or 117 million people, were living with a chronic disease, 

and of this group, about 60 million were living with two or more chronic diseases.1

 Specifically, 

■ More than 15 million U.S. adults aged 20 years or older (6.4% of the population) had coronary heart 

disease in 2007–2010.21

■ In 2010, more than 6 million adults aged 18 years or older (2.6% of the population) reported ever 

having had a stroke.22

■ In 2012, more than 29 million people (9.3% of the population) had diabetes, a disease that can lead 

to other serious health complications, including heart disease, blindness, kidney failure, and lowerextremity amputations.23

■ More than 1.5 million people were diagnosed with cancer in 2011, and more than 13 million are living 

with the disease.24,25

■ During 2011–2012, more than one-third of adults aged 20 years or older and 1 out of every 6 children 

and adolescents aged 2–19 years had obesity.26

 Children with obesity have an increased risk of type 2 diabetes,27 high blood pressure,28,29 and being 

obese as an adult.30-32

 Adults with obesity have an increased risk of coronary heart disease, type 2 diabetes, some types of 

cancers (e.g., postmenopausal breast, colorectal), osteoarthritis, and stroke.33

■ About 16 million adults aged 18 years or older and more than 2 million adolescents aged 12–17 years 

had a major depressive episode in 201234 that negatively affected their ability to work, sleep, study, 

eat, and enjoy life.35

Some population groups are disproportionally affected by chronic disease. In general, the prevalence of 

chronic disease increases with age, varies by race/ethnicity, and is higher among people with lower education 

or income levels.36-38
4

In addition to negatively affecting the lives of individuals, chronic diseases are costly to the United States. In 

2012, health care expenses for people who live in the community were $1.35 trillion, and chronic diseases 

ranked as four of the top five most costly conditions.39 Not surprisingly, as the number of chronic conditions 

that a person has increases, health care spending also increases substantially.3

Benefits of Physical Activity

Physical activity can reduce illness from chronic diseases and premature death.7 People who are physically 

active have about a 30% lower risk of early death than people who are inactive.7

 Even low amounts of 

physical activity reduce this risk.7

 Conversely, physical inactivity accounts for about 11% of premature deaths 

in the United States.40,41 The benefits of physical activity in preventing chronic disease are numerous and wellestablished.6,7 Regular physical activity helps prevent risk factors for disease (such as high blood pressure) and 

protect against multiple chronic diseases (such as heart disease, stroke, some cancers, type 2 diabetes, and 

depression).6,7

Health Benefits Associated with Regular Physical Activity

Children and Adolescents Adults

■ Improved cardiorespiratory fitness.

■ Improved muscular fitness.

■ Improved bone health.

■ Favorable body composition.

■ Improved markers of cardiovascular 

and metabolic health.

■ Lower risk of early death.

■ Lower risk of heart disease and stroke.

■ Lower risk of high blood pressure and 

adverse blood lipid profile.

■ Lower risk of type 2 diabetes.

■ Lower risk of colon and breast cancer. 

■ Lower risk of metabolic syndrome.

■ Prevention of weight gain.

■ Weight loss, particularly when combined 

with reduced calorie intake.

■ Improved cardiorespiratory fitness.

■ Improved muscular fitness.

■ Prevention of falls.

■ Reduced depression.

■ Better cognitive function (for older adults).

Source: 2008 Physical Activity Guidelines for Americans.

6

Note: Strong evidence supports the association of physical activity with these health benefits.

People living with chronic disease—such as heart disease, diabetes, osteoporosis, cancer, depression, and 

arthritis—can get a variety of health benefits from being physically active.7,8,42-54 For example, people with 

heart disease, type 2 diabetes, or high blood pressure can lessen the severity of their condition, as well as 

prevent disease progression and premature death.7,46-50 For other diseases, such as arthritis and depression, 

physical activity helps people manage or reduce symptoms.42-45 For example, during 2010–2012, more than 

52 million adults were living with arthritis,55 and this population could potentially reduce joint pain and other 
5

symptoms of arthritis through physical activity.42,45,56 People with chronic disease often get multiple health 

benefits from physical activity. For example, for people with type 2 diabetes, increased physical activity can 

improve insulin sensitivity and blood glucose control, while also reducing other cardiovascular risk factors and 

improving mobility.47,50

Among adults, physical activity is associated with improved quality of life,7,57,58 emotional well-being,7,59,60 and 

positive mental health.7,59-61 Some evidence suggests that physical activity in children and adolescents can 

lower levels of anxiety and depression.7,62-64 It can also help improve health-related quality of life for people 

with chronic disease.7 For example, in several cancer survivor groups, physical activity was associated with 

improvements in physical function, quality of life, and cancer-related fatigue.65,66

For adults, regular physical activity helps prevent weight gain, contributes to weight loss (particularly when 

combined with reductions in calorie intake), and helps with weight maintenance after weight loss.6,7 Regular 

physical activity also helps children and adolescents have a more favorable body composition.6,7

Academic benefits are also associated with regular physical activity. When schools encourage participation in 

physical activity as part of physical education, recess, classroom lessons, or extracurricular activities, students 

can improve their academic performance, as shown by improvements in grades and standardized test 

scores.67,68 Physical activity can also help students improve their cognitive skills and their ability to concentrate 

and pay attention.67,68

Regular physical activity is also important for healthy aging.6 Physical activity helps improve balance, stamina, 

flexibility, joint mobility, agility, walking, and overall coordination.69 Regular physical activity can help extend 

years of active independent life, reduce functional limitations, and reduce the risk of falls.8,69,70 Physical 

activity can also help to prevent or delay conditions that are especially worrisome for older adults, such 

as osteoporosis and muscle loss.70-72 Physical activity may also delay the onset of cognitive decline in older 

adults.7,73-75

In addition to the health benefits, regular physical activity may be associated with lower health care costs.76-79

A recent study compared health care expenditures among adults with different levels of physical activity and 

found that $117 billion (in 2012 dollars; 11% of aggregate health care expenditures) annually were associated 

with inadequate levels of physical activity.76

Physical Activity Guidelines for Americans

In 2008, the U.S. Department of Health and Human Services issued the first Physical Activity Guidelines for 

Americans.

6

 These guidelines outline the health benefits associated with physical activity and provide guidance 

for the amount of physical activity needed for substantial health benefits (see box, page 6). People who are 

inactive and those who do not yet meet the guidelines are strongly encouraged to work toward this goal. 

Those who are inactive and become more active may reap the most benefits.7 Adults with disabilities who 

are unable to meet the guidelines should avoid inactivity and try to get regular physical activity according to 

their abilities.6

Physical Activity in the United States

In 2013, about 3 out of every 10 U.S. adults reported being inactive during their leisure time (Figure 1), and 

only one-half reported levels of physical activity consistent with the guideline for aerobic physical activity 

(Figure 2).80 Physical inactivity was more common among women; people who were older, black, or Hispanic; 
6

and people with lower levels of education (Figure 1). Conversely, adults who were male, younger, white, or 

Asian or who had higher levels of education were more likely to meet the aerobic component of the 2008

Physical Activity Guidelines for Americans (Figure 2). In addition, the percentage of older adults who were 

inactive increased with increasing age: 35% of those aged 65–74 years were inactive, 47% of those 75–84 

years were inactive, and 64% of those 85 years or older were inactive. Conversely, the percentage of older 

adults who met the aerobic guideline decreased with increasing age: 42% of those aged 65–74 years, 31% 

of those aged 75–84 years, and 18% of those aged 85 years or older.

From the 2008 Physical Activity Guidelines for Americans6

Key Guidelines for Adults 

■ All adults should avoid inactivity. Some physical activity is better than none, and adults who 

participate in any amount of physical activity gain some health benefits. 

■ For substantial health benefits, adults should do at least 150 minutes (2 hours and 30 minutes) a 

week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) a week of vigorous-intensity 

aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity 

aerobic activity. Aerobic activity should be performed in episodes of at least 10 minutes, and 

preferably, it should be spread throughout the week. 

■ For additional and more extensive health benefits, adults should increase their aerobic physical 

activity to 300 minutes (5 hours) a week of moderate-intensity, or 150 minutes a week of 

vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and 

vigorous-intensity activity. Additional health benefits are gained by engaging in physical activity 

beyond this amount. 

■ Adults should also do muscle-strengthening activities that are moderate or high intensity and 

involve all major muscle groups on 2 or more days a week, as these activities provide additional 

health benefits.

Key Guidelines for Children and Adolescents

■ Children and adolescents should do 60 minutes (1 hour) or more of physical activity daily. 

 Aerobic: Most of the 60 or more minutes a day should be either moderate- or vigorousintensity aerobic physical activity, and should include vigorous-intensity physical activity at 

least 3 days a week. 

 Muscle-strengthening: As part of their 60 or more minutes of daily physical activity, children 

and adolescents should include muscle-strengthening physical activity on at least 3 days of 

the week. 

 Bone-strengthening: As part of their 60 or more minutes of daily physical activity, children 

and adolescents should include bone-strengthening physical activity on at least 3 days of 

the week.

■ It is important to encourage young people to participate in physical activities that are 

appropriate for their age, that are enjoyable, and that offer variety.
7

Figure 1. Percentage of U.S. Adults Aged 18 Years or Older Who Were Inactive During Their 

Leisure Time, 2013

Abbreviations: AI/AN, American Indian/Alaska Native; HS, high school; NH, non-Hispanic. 

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey (NHIS).

Notes: Estimates are age-adjusted (except those by age group) to the 2000 U.S. standard population using five age groups: 18–24 years, 25–34 years, 

35–44 years, 45–64 years, and 65+ years. Estimates by race are for people who reported only one race. People of Hispanic ethnicity may be of any race. 

Estimates are not presented for Native Hawaiians or Other Pacific Islanders because the NHIS public-use data sets do not provide the necessary level 

of detail. Estimates by education are limited to people aged 25 years or older. NHIS questions ask about frequency and duration of light-intensity to 

moderate-intensity and vigorous-intensity leisure-time physical activity. Inactivity for adults is defined as reporting no leisure-time physical activity that 

lasted at least 10 minutes. Error bars represent upper and lower bounds of the 95% confidence interval.

Figure 2. Percentage of U.S. Adults Aged 18 Years or Older Who Met the Aerobic Physical 

Activity Guideline, 2013

Abbreviations: AI/AN, American Indian/Alaska Native; HS, high school; NH, non-Hispanic. 

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey (NHIS).

Notes: Estimates are age-adjusted (except those by age group) to the 2000 U.S. standard population using five age groups: 18–24 years, 25–34 years, 

35–44 years, 45–64 years, and 65+ years. Estimates by race are for people who reported only one race. People of Hispanic ethnicity may be of any race. 

Estimates are not presented for Native Hawaiians or Other Pacific Islanders because the NHIS public-use data sets do not provide the necessary level 

of detail. Estimates by education are limited to people aged 25 years or older. NHIS questions ask about frequency and duration of light-intensity to 

moderate-intensity and vigorous-intensity leisure-time physical activities. Meeting the aerobic component of the 2008 Physical Activity Guidelines for 

Americans is defined as reporting at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic physical activity a week, or an 

equivalent combination. Error bars represent upper and lower bounds of the 95% confidence interval.

The first part of 

Figure 1 shows 

that 28% of 

men and 32% 

of women were 

inactive during 

their leisure time 

in 2013.

The second part of Figure 1 shows 

that 24% of adults aged 18-24, 

24% of those 25-34, 27% of those 

35-44, 33% of those 45-64, and 42% 

of those 65 or older were inactive 

during their leisure time in 2013.

The third part of Figure 1 shows that 

27% of non-Hispanic whites, 39% of 

non-Hispanic blacks, 29% of Asians, 

34% of American Indians or Alaska 

Natives, and 40% of Hispanics were 

inactive during their leisure time in 

2013.

The fourth part of Figure 1 

shows that 52% of adults 

with less than a high school 

education, 40% of those with a 

high school education, 30% of 

those with some college, and 

17% of college graduates were 

inactive during their leisure 

time in 2013.

52

40

30

17

27

39

29

34 40

24 24 27

33

42

PERCENTAGE

28

32

100

0

20

40

60

80

Men Women

SEX

18-24

AGE

25-34 35-44 45-64 65+ NH White

RACE/ETHNICITY

NH Black Asian AI/AN Hispanic <HS

EDUCATION

HS Some 

college

College

graduate

The first part of 

Figure 2 shows 

that 54% of 

men and 46% of 

women met the 

aerobic physical 

activity guideline 

in 2013. 

The second part of Figure 2 shows 

that 61% of adults aged 18-24, 57% 

of those 25-34, 53% of those 35-44, 

46% of those aged 45-64, and 36% 

of those 65 or older met the aerobic 

physical activity guideline in 2013.

The third part of Figure 2 shows that 

53% of non-Hispanic whites, 41% of 

non-Hispanic blacks, 50% of Asians, 

47% of American Indians or Alaska 

Natives, and 43% of Hispanics met the 

aerobic physical activity guideline in 

2013.

The fourth part of Figure 2 

shows that 31% of adults 

with less than a high school 

education, 40% of those with 

a high school education, 50% 

of those with some college, 

and 61% of college graduates 

met the aerobic physical 

PERC

activity guideline in 2013.

ENTAGE

54

46

100

0

20

40

60

80

Men Women

SEX

18-24

AGE

25-34 35-44 45-64 65+

61

57

53

46

36

NH White

RACE/ETHNICITY

NH Black Asian AI/AN Hispanic

53

41

50 47

43

<HS

EDUCATION

HS Some 

college

College

graduate

31

40

50

61
8

In 2013, only 27% of high school students reported levels of physical activity that met the guideline for 60 

minutes of physical activity a day (Figure 3).10 Male high school students and students in lower grade levels 

were more likely to meet the guideline; no differences were observed by race.10,80

Figure 3. Percentage of U.S. High School Students Who Met the Aerobic Physical Activity 

Guideline, 2013

Abbreviations: AI/AN, American Indian/Alaska Native; NH, non-Hispanic; NH/PI, Native Hawaiian/Other Pacific Islander.

Source: Centers for Disease Control and Prevention, Youth Risk Behavior Surveillance System.

Notes: Meeting the aerobic component of the 2008 Physical Activity Guidelines for Americans is defined as reporting at least 60 minutes of “any kind 

of physical activity that increases your heart rate and makes you breathe hard some of the time” on all days during the 7 days before the survey. 

Estimates by race are for students who reported only one race. People of Hispanic ethnicity may be of any race. Error bars represent upper and lower 

bounds of the 95% confidence interval.

The first part of 

Figure 3 shows 

that 37% of 

male high school 

students and 

18% of female 

students met the 

aerobic physical 

activity guideline 

in 2013.

The second part of Figure 3 shows 

that 30% of students in grade 9, 28% 

of those in grade 10, 26% of those in 

grade 11, and 24% of those in grade 

12 met the aerobic physical activity 

guideline in 2013.

The third part of Figure 3 shows that of 28% 

of non-Hispanic white students, 26% of 

non-Hispanic black students, 21% of Asian 

students, 31% of American Indian or Alaska 

Native students, 24% of Native Hawaiian or 

Other Pacific Islander students, and 26% of 

ical 

PERCENTAGE

Male Female

SEX

50

0

10

20

30

40

60

9th

GRADE

10th 11th 12th NH White

RACE/ETHNICITY

NH Black Asian AI/AN Hispanic

31

NH/PI

30

28

26 24

28 26 21

24

26

37

18
9

Why Focus on Walking as a

Public Health Strategy?

Strong evidence exists that physical activity has substantial health benefits.6,7 People can get these benefits 

through brisk walking or by adding brisk walking to other physical activities.6 This section reviews the 

relevance and importance of walking as a public health strategy to increase physical activity levels in the 

United States.

Walking Is an Easy Way to Start and Maintain a Physically 

Active Lifestyle

Walking does not require special skills, facilities, or expensive equipment and is an easy physical activity to 

begin and maintain as part of a physically active lifestyle.81 Walking begins early in life and, for the most part, 

continues throughout the lifespan.69 Most people are able to walk, and many people with disabilities are able 

to walk or move with assistive devices, such as wheelchairs or walkers. In addition, walking is a year-round 

activity that can be done indoors or outdoors.

Walking may be a good way to help people who are inactive become physically active.6,82 Walking intensity, 

duration, and frequency are self-determined, and people can tailor their walking patterns to fit their time, 

needs, and abilities.82 Walking also has a lower risk of injury than vigorous-intensity activities, such as 

running.6 The amount and intensity of walking can be gradually increased over time to minimize the risk of 

injury, and walking promotion programs can include injury prevention efforts.6,83

Walking Is a Common Form 

of Physical Activity 

Walking is common among people who are 

physically active. Among adults who reported any 

physical activity in 2011, 52% of men and 74% of 

women reported walking as one of the top two 

activities in which they participated.84 Similarly, 

when high school students were asked about 

the physical activities they did during the past 12 

months, they most frequently reported walking 

(81% of boys and 87% of girls).85 Among schoolaged youth (6–17 years), about 40% who live 1 mile 

or less from school reported that they usually walk 

to or from school on most days.86

In 2010, more than 60% of adults reported 

walking 10 minutes or more in the past week for 

transportation or leisure.87 Some groups were more 

likely to report walking than others (Figure 4).87

Adults with more education, those who were white 
10

or Asian, and those who were younger were more likely than their counterparts to report any walking. No 

differences were observed between men and women.87 Percentages of older adults who reported walking 

decreased with increasing age: 59% of those aged 65–74 years, 49% of those aged 75–84 years, and 41% of 

those aged 85 years or older.

Figure 4. Percentage of U.S. Adults Aged 18 Years or Older Who Reported Any Walking in 

the Past Week, 2010

Abbreviations: AI/AN, American Indian/Alaska Native; HS, high school; NH, non-Hispanic.

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey (NHIS).

Notes: Estimates are age-adjusted (except those by age group) to the 2000 U.S. standard population using five age groups: 18–24 years, 25–34 years, 

35–44 years, 45–64 years, and 65+ years. Estimates by race are for people who reported only one race. People of Hispanic ethnicity may be of any race. 

Estimates are not presented for Native Hawaiians or Other Pacific Islanders because the NHIS public-use data sets do not provide the necessary level of 

detail. Walking is defined as one period of 10 minutes or more in the preceding 7 days. Any walking includes both transportation (“to get some place”) 

and leisure (“for fun, relaxation, exercise, or to walk the dog”). Error bars represent upper and lower bounds of the 95% confidence interval.

Among people who walked, the average time spent walking was 13 minutes a day or about 90 minutes a 

week.87 These average walking times, when walking is done at a brisk pace, provide slightly more than half 

of the time needed to meet the guideline of at least 150 minutes of aerobic physical activity each week. Not 

surprisingly, about 60% of people who walked met the guideline by walking alone or in combination with 

other forms of physical activity (e.g., running, biking), compared with 30% of those who did not walk.87

Walking Is Multipurpose

People walk for many purposes, such as for transportation to get to school, work, a store, or the library or for 

leisure to have fun, socialize with friends or family, walk their dog, or improve their health. Because walking is 

multipurpose, it provides many opportunities for people to incorporate physical activity into their busy lives. 

In 2010, about half of U.S. adults reported walking during their leisure time and less than one-third reported 

walking for transportation (Table).88 Younger adults walked more than older adults for transportation, while 

walking for leisure was similar across the lifespan until it decreased among adults older than 65 years.88

Whites and Asians were more likely than Hispanics and blacks to walk during leisure time; whites were less 

The first part of 

Figure 4 shows 

that 62% of men 

and women 

reported any 

walking in the 

past week in 

2010.

The second part of Figure 4 shows 

that 65% of adults aged 18-24, 65% 

of those 25-34, 64% of those 35-44, 

62% of those aged 45-64, and 54% 

of those 65 or older reported any 

walking in the past week in 2010.

The third part of Figure 4 shows that 

63% of non-Hispanic whites, 54% of 

non-Hispanic blacks, 66% of Asians, 

62% of American Indians or Alaska 

Natives, and 60% of Hispanics reported 

any walking in the past week in 2010.

The fourth part of Figure 4 

shows that 52% of adults 

with less than a high school 

education, 55% of those with 

a high school education, 62% 

of those with some college, 

and 72% of college graduates 

reported any walking in the 

PERC

past week in 2010.

ENTAGE

62 62

100

0

20

40

60

80

Men Women

SEX

18-24

AGE

25-34 35-44 45-64 65+

65 65 64 62

54

NH White

RACE/ETHNICITY

NHBlack Asian AI/AN Hispanic

63

54

66 62

60

<HS

EDUCATION

HS Some 

college

College

graduate

52 55

62 72

72
11

likely to walk for transportation than members of other racial and ethnic groups. Adults with more education 

were more likely to walk during leisure time and those with college degrees were also more likely to walk for 

transportation than those with less education.88 Understanding these differences may help to increase the 

effectiveness and reach of interventions that encourage walking.

Table. Percentage of U.S. Adults Aged 18 Years or Older Who Reported Walking for 

Transportation or During Leisure Time, 2010

Characteristics Transportation

% (95% CI)

Leisure

% (95% CI)

Sex

Men 32.0 (30.8, 33.2) 48.5 (47.3, 49.8)

Women 26.9 (25.8, 28.0) 51.5 (50.3, 52.7)

Age (years)

18–24 39.0 (36.4, 41.7) 48.2 (45.8, 50.6)

25–34 33.2 (31.4, 35.1) 51.7 (49.8, 53.6)

35–44 29.4 (27.8, 31.1) 52.6 (50.6, 54.5)

45–54 27.9 (26.3, 29.6) 51.5 (49.7, 53.3)

55–64 27.9 (26.2, 29.7) 51.7 (49.5, 53.8)

65–74 22.9 (21.0, 24.8) 48.8 (46.4, 51.2)

75–84 18.1 (15.9, 20.4) 38.3 (35.4, 41.2)

85+ 13.7 (10.3, 17.2) 33.0 (27.9, 38.0)

Race/Ethnicity

White, non-Hispanic 28.1 (27.0, 29.2) 51.7 (50.6, 52.8)

Black, non-Hispanic 30.6 (28.6, 32.6) 41.2 (39.1, 43.4)

Asian 33.5 (30.8, 36.2) 52.6 (49.3, 55.8)

American Indian or Alaska Native 29.1 (21.9, 37.5) 52.1 (43.8, 60.4)

Hispanic 32.8 (31.0, 34.8) 47.5 (45.6, 49.4)

Education

Less than high school 28.8 (27.0, 30.6) 37.7 (35.9, 39.6)

High school graduate 24.1 (22.9, 25.3) 43.6 (42.0, 45.1)

Some college 29.1 (27.7, 30.5) 51.0 (49.5, 52.6)

College graduate 35.0 (33.6, 36.5) 61.0 (59.4, 62.6)

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey (NHIS).

Notes: Estimates by race are for people who reported only one race. People of Hispanic ethnicity may be of any race. Estimates are not 

presented for Native Hawaiians or Other Pacific Islanders because the NHIS public-use data sets do not provide the necessary level of detail. 

Walking is defined as one period of 10 minutes or more in the preceding 7 days. Transportation walking is defined as walking “to get some 

place” and walking during leisure is walking “for fun, relaxation, exercise, or to walk the dog.” Numbers in parentheses represent upper and 

lower bounds of the 95% confidence interval (CI).
12

Walking Benefits Communities

Communities can benefit when they implement strategies that make them more walkable, such as making 

streets pedestrian friendly; building houses, shops, and other destinations close together (mixed land use); 

and increasing access to public transit. The benefits of improved walkability and more people walking 

regularly can include making communities safer, supporting social cohesion, reducing air pollution, and 

benefiting local economies.

Makes Communities Safer 

Communities designed to be walkable often include crossing signals, pedestrian signs, and features to slow 

vehicle speed.89-91 These design features can improve safety for pedestrians and all community members. 

Programs such as Safe Routes to School provide a safe environment for children to walk and bike to school, 

which can reduce traffic-related injuries among school-aged children.92 These programs also improve the 

walking and biking environment around schools for all users.93

Supports Social Cohesion

Walkable communities and communities where more people walk offer opportunities for personal interaction 

and social involvement.94 In these communities, people can walk with family members or friends, stop to 

chat with neighbors while walking their dog, walk to a local store or bus stop with a friend, meet regularly for 

a group walk, or participate in a “walking meeting” with colleagues. These interactions help strengthen the 

personal bonds that bring people and communities together, creating more social cohesion.

Reduces Air Pollution

Communities designed to be walkable have the potential to reduce air pollution and greenhouse 

gases because people may choose to walk or bike rather than drive.95,96 Studies have shown that when 

environments become more walkable, a larger proportion of trips are made by walking or biking.96,97 One 

study showed that when people moved to a neighborhood designed to promote physical activity and active 

transportation, they reported spending less time in their cars and more time walking for transportation.97

The U.S. Department of Transportation estimated that when communities participating in the Nonmotorized 

Transportation Pilot Project became more walkable and bikeable, the proportion of walking trips increased 

by 16% over 5 years and the proportion of biking trips increased by 44%.96 The study concluded that this shift 

could potentially result in lower emissions of carbon dioxide, hydrocarbons, nitrogen oxide, carbon monoxide, 

and particulate matter.96

Benefits Local Economies

Walkable communities are attractive places for businesses to locate, which may help local economies 

thrive.98,99 Features of a walkable community—safer and pedestrian-friendly streets, mixed land use, and 

access to transit—are associated with economic benefits to the community.98-100 These benefits include 

neighborhood revitalization, higher home values, higher levels of retail activity and employment, and lower 

costs of delivering services such as utilities.98-100 
13

Why Don’t People Walk More?

Many more people could meet the 2008 Physical 

Activity Guidelines for Americans6 by initiating 

walking or increasing the amount they walk. 

Although walking is a popular form of physical 

activity and can be easily done by most people, 

barriers to walking do exist. Understanding these 

barriers is essential to designing and implementing 

approaches that promote walking. This section 

reviews the most significant barriers to walking.

Not Enough Time to Walk

People report lack of time as one challenge that 

prevents them from walking or doing other kinds 

of physical activity.101,102 Many people spend a 

significant amount of their day at work. In 2013, 

a U.S. worker aged 15 years or older worked an 

average of 7.6 hours on a workday.103 Over the 

last 50 years, the percentage of people who work 

in occupations that require physical activity has 

progressively decreased,104 making it difficult for 

adults to be physically active during work hours. 

Adults may struggle to meet the current guideline of 

at least 150 minutes of aerobic physical activity each 

week as they balance the competing demands of 

work, home, and caring for themselves and others. 

However, many adults have some flexibility with 

their leisure time and may be able to substitute 

walking for less active pursuits. 

Children and adolescents also live busy lives that may make it challenging to meet the guideline of 60 minutes 

or more of physical activity a day. Schools, which could provide most young people with opportunities to be 

active, increasingly face competing priorities, as well as time and resource challenges.105 In 2012, only 58.9% 

of districts required that elementary schools provide students with regularly scheduled recess.106 In 2013, 

only 48.0% of high school students went to physical education classes on at least 1 day during an average 

week.10 Outside of school hours, most children have leisure time. For example, young people aged 8–18 years 

spend an average of more than 4 hours a day watching television.107 Reducing television viewing and other 

forms of screen time may be one way to help young people add more physical activity to their lives.108

Safety Concerns

Safety concerns can be a barrier to walking. In 2013, a total of 4,735 pedestrians were killed and an 

estimated 66,000 were injured in motor vehicle-related crashes.109 The proportion of vehicle-related 

pedestrian fatalities has increased in recent years, from 11% in 2004 to 14% in 2013,110 which further 
14

reinforces the need to consider safety. Thirty-seven states emphasize walking in their State Highway Safety 

Plans.111 Although pedestrian safety concerns may be addressed through improvements that benefit all 

road users (e.g., intersection redesigns that include improved crosswalks as part of other vehicle-related 

safety enhancements), less than 1% of the funds that states administer from the federal Highway Safety 

Improvement Program are directed exclusively toward pedestrian and bicycle programs.111

Pedestrian deaths and injuries are associated with vehicle-related factors, unsafe driver and pedestrian 

behaviors, and problematic physical environments. Vehicle-related factors (such as the speed and volume 

of traffic) and driver behaviors (such as distracted driving, driving under the influence of drugs or alcohol, 

speeding, and reckless and aggressive driving) all pose significant safety risks to pedestrians.89,112-114 Pedestrian 

behaviors associated with risk include use of alcohol, distracted walking, crossing in the middle of a block, and 

crossing against a traffic light.89,112,113,115,116

Physical environments—such as a lack of sidewalks and crosswalks, poor lighting, streets with high-speed 

traffic, and poorly timed crossing signals—also contribute to increased pedestrian risk.89,90,113 In 2012, more 

than 3 out of every 10 people aged 16 years or older reported that no sidewalks existed along any street 

in their neighborhood.117 Basic infrastructure elements—such as sidewalks, curb cuts, crosswalks, lighting, 

and crossings for the visually impaired—are particularly important for the safety of people with visual and 

mobility limitations, parents with young children in strollers, and older adults.118

Perceived traffic dangers may be barriers to walking. In surveys of parents, the most commonly reported 

barrier for walking to school was distance to school, followed by traffic-related dangers.119,120 Some studies 

have shown that traffic-related fears discourage walking among adults,121,122 but researchers have not 

determined how this association is modified by other contextual factors, such as walking purpose and 

characteristics of people who walk.

Fear of crime or perceptions of an unsafe neighborhood may also be potential barriers to walking.123,124

The evidence is mixed on whether higher levels of documented crime are associated with walking. Some 

studies have shown that measures of documented violent crime are associated with reduced walking or 

physical activity among minority groups and some inner-city populations.125,126 However, other studies have 

found no association between walking or physical activity when examining documented property crime or 

perceptions of neighborhood crime.127,128

Community Design

The ways in which communities are designed and built can present barriers to walking. Large distances often 

exist between home, school, work, stores, and other frequently sought destinations,129,130 and this distance 

can limit people’s ability to incorporate walking into their everyday activities. Lack of an adequate public 

transit system can also result in missed walking opportunities. In addition, poorly maintained sidewalks and 

trails and the introduction of conveniences—such as moving walkways and escalators—may discourage 

walking.

Research has shown that, on average, people will walk about half a mile to reach a destination.131,132 When 

everyday destinations—such as a grocery store, a library, schools, and restaurants—are located too far 

away from home, walking will not be a convenient option.121,127,129,133 Several elements of community design 

contribute to long distances between destinations and the likelihood of walking trips, including sprawling land 

use patterns and lack of connectivity.121,134
15

The distance between home and school is strongly associated with whether students walk to school.135,136

In 2009, only about 22% of students in kindergarten through 8th grade reported living less than 1 mile from 

their school, and 35% of this group reported that they usually walked or biked to school on most school 

days.137 In comparison, only 6% of students living 1–2 miles from school and only 2% of those living 2 miles 

from school or farther usually walked or biked to school on most school days.137

Because people are more likely to walk when they use public transportation (e.g., walking to stops or stations, 

walking through stations),129,138-145 the lack of an adequate public transit system may mean that opportunities 

to walk are lost. People tend to walk more when they have access to high-quality (e.g., convenient, comfortable) public transit systems.146 Land use patterns, connectivity, and block sizes can affect the ability of public 

transit systems to provide a viable alternative to driving.129

Disability, Chronic Conditions, and Aging 

During 2009–2012, 11.6% of U.S. adults aged 

18–64 years reported a disability, with estimates 

ranging from 1.7% for vision-related disabilities 

to 5.8% for mobility-related disabilities.147 Adults 

with disabilities were more likely to be physically 

inactive than adults without a disability (47.1% 

versus 26.1%).147 Some disabilities can make 

it difficult for people to walk without assistive 

devices.

Although many people with disabilities are able to 

be physically active, additional barriers exist that 

may limit their participation in some activities. 

These barriers include limited information about 

accessible facilities and programs, physical 

barriers in the environment, physical or emotional 

barriers to participating in fitness and recreational 

activities, and lack of training in accessibility and 

communication among fitness and recreation 

professionals.148

Chronic conditions and age can also make it 

difficult for people to walk. For example, people 

with arthritis may find walking painful, and they 

may be uncertain about how to walk safely 

without worsening their arthritis.56,149 For people 

with asthma, heart disease, and respiratory 

diseases, symptoms may be exacerbated when 

walking outdoors because of air pollution.150,151

Older adults and those who are frail may be 

reluctant to walk because of concerns about falls 

and subsequent injury. 
16

How to Increase Walking

and Improve Walkability

Ultimately, individuals make the decision to 

walk. However, the decision to walk can be made 

easier by programs and policies that provide 

opportunities and encouragement for walking 

and by improvements to community walkability. 

Improving walkability means that communities 

are created or enhanced to make it safe and easy 

to walk and that pedestrian activity is encouraged 

for people of all ages and abilities.11

This section focuses on community strategies 

as a way for our nation to support walking 

and walkability. Strategies at the community 

level generally have greater reach and result in 

longer lasting change than strategies focused 

on individual behavior.152 These strategies are 

based primarily on recommendations from 

the Community Preventive Services Task Force 

on approaches to increase physical activity in 

the community153,154 and supplemented with 

other evidence from the scientific literature. 

This section discusses what communities can 

do to promote walking, the evidence for these 

strategies, and key roles that different sectors of 

society can play to support walking and walkability. 

Design Communities and Streets that Support Walking

Community and street design policies are recommended approaches for increasing physical activity, including 

walking.153,155 Community design can support physical activity, for example, by locating residences within short 

walking distance of stores, worksites, public transportation, essential services, and schools and by building 

sidewalks or paths between destinations that are well-connected, safe, and attractive.153,155 Communities with 

well-connected street networks have shorter blocks and more intersections, and they make walking along 

and across roads and between everyday destinations—such as schools, stores, senior centers, health care 

providers, and homes—direct and convenient.121,156 Trips served by well-connected pedestrian networks allow 

people of all ages and abilities to reach their destinations safely and conveniently.

Street design can also support walking and enhance pedestrian safety through measures that improve street 

lighting and landscaping and reduce traffic speed.153,155 Sidewalks and features that separate pedestrians from 

bicyclists and motor vehicles encourage walking and make walking safer.91,157,158 Pedestrian safety is enhanced 

through street design features that decrease vehicle speeds and increase the number of safe pedestrian 

crossings, such as medians and pedestrian crossing islands.89-91,159

Photo courtesy of www.pedbikeimages.org/Carl Sundstrom
17

Transportation and travel policies and practices that create or enhance pedestrian and bicycle networks and 

expand or subsidize public transit systems can be another approach to encourage walking and biking for 

transportation. Although the Community Preventive Services Task Force found insufficient evidence for these 

practices in 2004,155 more recent reviews conducted by the National Institute for Clinical Excellence160 and the 

National Academy of Science’s Transportation Research Board130 found evidence that a variety of transportation 

policies offer effective ways to promote both leisure-time and transportation-related physical activity.

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.154,161 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.154,161,162 Places for physical activity and informational outreach are 

complementary efforts that together provide stronger support for physical activity.163

Social Support

Social support interventions increase physical activity by providing supportive relationships for behavior 

change.163 They include actions that provide friendship and support (e.g., buddy systems, contracts with others 

to complete specified levels of physical activity, walking groups).154,161 The use of social support interventions 

in community settings is a recommended approach to increase physical activity.154,161 Consistent with this 

recommendation, a recent meta-analysis concluded that interventions designed to promote walking in groups 

increase physical activity.164 Recommended practices for establishing and maintaining walking groups include 

canvassing the community, engaging partners, organizing resources, and recruiting walking leaders.165

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.163 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.163 Programs can be delivered face-to-face or by the use of mail, telephone, or 

computer technology.163
18

The use of individually-adapted health behavior change programs is a recommended strategy to increase 

physical activity.154,161 A Cochrane review found that interventions that included components of individuallyadapted health behavior change programs had a positive effect on increasing physical activity.166 The 

Cochrane review also noted that telephone support and printed educational materials helped people initiate 

and increase their physical activity levels.163,166

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.161,163,167 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.163 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.161,163,167

According to the Community Preventive Services Task Force, community-wide campaigns can be effective 

in increasing physical activity and are therefore a recommended strategy.161,168 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.169 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).169

What Sectors Are Needed to Help Implement 

Community Approaches?

Many groups have a role to play to make the United States a nation with safe, easy, and desirable places to 

walk as part of our daily lives. By working together across sectors of society at local, state, and national levels, 

we can achieve this goal.12,20 The 2010 National Physical Activity Plan provides overarching strategies, as 

well as strategies and tactics for various sectors of society, for increasing physical activity across the United 

States.20 This plan includes recommendations for transportation, land use, and community design; parks, 

recreation, and fitness; education (schools, colleges, and universities); worksite (business, industry, and other 

employers); volunteer and nonprofit; health care; media; and public health sectors.20 This section briefly 

describes the roles that each sector can play—and in some cases are already playing—to support walking 

and walkability.

Transportation, Land Use, and Community Design

The transportation, land use, and community design sector has a role in walking and walkability by managing 

federal, state, tribal, territorial, and local resources that support roadways, sidewalks, bikeways, public 

transit, community planning and zoning, and economic development.170-172 This sector includes transportation 

engineers, transportation and community planners, architects, and other design professionals, as well as 

members of planning commissions and planning boards. Everyone in the United States uses roads, and most 

people use sidewalks and live in communities that have planned how their land will be used. Nearly everyone 

is affected by the decisions and plans of this sector.
19

Photo courtesy of the U.S. Environmental Protection Agency

Decisions and plans made by the transportation, land use, and community design sector can affect whether 

communities and streets are designed to support walking. A 2010 policy statement by the U.S. Department 

of Transportation (DOT) specifically stated that, “Every transportation agency, including DOT, has the 

responsibility to improve conditions and opportunities for walking and bicycling and to integrate walking and 

bicycling into their transportation systems.”173 This sector can change the design of communities and streets 

through roadway design standards, zoning regulations, and building codes.153 This sector can also improve 

the pedestrian experience through landscaping, street furniture, and building design.174 It can further ensure 

that sidewalks and streets are safe and accessible to all pedestrians by including features—such as Americans 

with Disabilities Act (ADA) curb cuts that reduce barriers to walking or wheeling and audible traffic signals for 

people with vision impairments—in design plans.147

Core principles of some of the approaches used by this sector, such as adoption of policies that promote 

Complete Streets158,175,176 and smart growth designs,177,178 help support the routine design and operation of 

streets and communities that are safe for all pedestrians, regardless of age, ability, or mode of transport. 

When linked together, interconnected facilities and design features create connected pedestrian networks 

that allow people of all ages and abilities to reach their destinations safely and conveniently. Key features 

found on Complete Streets include sidewalks, bike lanes, special bus lanes, comfortable and accessible transit 

stops, frequent crossing opportunities, median islands, accessible pedestrian signals, and curb extensions.176

As of December 2014, a total of 30 states and the District of Columbia and 664 regional and local agencies 

had adopted Complete Streets policies.179
20

The transportation, land use, and community design sector 

can ensure that efforts designed to promote walking also 

address safety issues and are accompanied by efforts to 

prevent injuries and fatalities. Urban design strategies that 

foster safe neighborhoods, streets, and outdoor spaces to 

encourage walking and biking and increase access to public 

transit can simultaneously be designed to reduce injuries and 

fatalities.91 This sector can help ensure that plans and policies 

designed to increase walking incorporate evidence-based 

strategies for safety, such as those outlined in a publication 

developed by the Center for Active Design called Active Design 

Supplement: Promoting Safety.

91

This sector is also integral in the planning and implementation 

of public transit systems. Use of public transit is associated 

with increased levels of walking.129,138-145 For example, a 

national study reported that people who use public transit 

walk an additional 21 minutes a day walking to and from 

a transit stop or station.144 Creating walkable communities 

around transit hubs can further encourage walking.180,181

However, improvements to community infrastructures, such as improved green space, transportation 

systems, and walking paths, may result in unintended consequences or inequitable distribution of benefits. 

Improvements to infrastructure may increase property values and lead to gentrification, where low-income 

residents are unable to pay increased rents or property taxes and are displaced by people with higher 

incomes.182,183 Members of the transportation, land use, and community design sector should consider 

potential unintended consequences and work to minimize and mitigate these negative effects when they 

develop and implement community design plans and policies.184 This sector can also work to ensure an 

equitable distribution of the benefits of walkability. For example, neighborhoods with a combination of 

high walkability and low air pollution have been shown to be located predominately in higher-income 

neighborhoods.185 In contrast, people living in low-income neighborhoods are disproportionally at risk of 

pedestrian death.186 The transportation, land use, and community design sector can help address issues that 

contribute to these types of disparities.

Parks and Recreational and Fitness Facilities

Public parks offer people access to places to walk.187,188 In 2013, nearly 274 million people visited national 

parks.189 About 720 million annual visits are made to more than 7,000 state parks in the United States that 

offer more than 38,000 miles of trails.190 In addition to national (and other federally owned recreational 

areas) and state parks, many cities and regions also have local parks. Nearly 40% of people in the United 

States live within one-half mile of a park boundary.191 Across the country, nearly 1,900 rail-trails (shared-use 

trails on converted rail lines or alongside rail lines) cover more than 21,000 miles.192

Evidence shows that people who have more access to green environments, such as parks, tend to walk more 

than those with limited access.193-196 Better access to parks, playgrounds, and recreational centers also may 

encourage active transportation, such as biking or walking to the location.197 Emerging evidence suggests that 

when parks add more signs and conduct outreach activities, the physical activity of park users increases.198
21

In 2012, more than 30,000 health clubs were being used by more than 50 million people.199 Living or working 

close to an exercise facility is related to adoption and maintenance of supervised physical activity programs 

and overall physical activity.200 Health and fitness facilities offer group walking programs and access to places 

for walking. For example, they provide indoor opportunities to walk during inclement weather or for people 

who prefer indoor or treadmill walking. These facilities can also provide options, such as warm water pools, 

to make walking safer and more comfortable for people with mobility limitations or chronic conditions such 

as arthritis. To ensure broad access to these benefits, facilities should be designed, built, and maintained to 

be accessible to the entire population.

Schools

In the United States, more than 130,000 elementary, middle, and high schools reach about 55 million 

students and 7.3 million teachers and staff members.201 Young people spend much of their time in school: 

6–7 hours a day for about 180 days a year.202

Schools can provide opportunities for physical activity through physical education, recess, after-school activity 

programs (including sports and physical activity clubs), and physical activity breaks,105,203 and walking can 

be incorporated into these opportunities. An Institute of Medicine report on physical activity and physical 

education in the school environment documented that physical education, recess, and after-school activity 

programs can increase physical activity among children and adolescents.105 Evidence is also emerging that 

classroom activity breaks can increase physical activity among youth.203-205

Schools can also encourage walking by promoting safe routes for students to walk to and from school through 

community-wide approaches. The Safe Routes to School program206 and other efforts where a group of 

students walk to school with one or more adults have contributed to increases in children walking to and 

from school.207 Walk-to-school programs have also helped to address the safety concerns of parents, a major 

challenge to children walking to school.208 Efforts can also be made to improve safety for those walking to 

school, such as building entrances and exits that do not flow directly into streets and setting up bus lanes that 

do not create safety hazards for children.

Opening school facilities, such as gyms, playgrounds, fields, and tracks, to the community during nonschool 

hours (often referred to as shared use or joint use)209 is a promising strategy to increase access to physical 

activity and recreational facilities210 and increase physical activity levels.211-213 Community members of all ages 

can use these facilities for many different physical activities, including walking, and opening these facilities to 

the community can also encourage walking from homes to these locations. 

Colleges and Universities

In the United States, more than 7,000 colleges and universities214 reach about 21 million students and employ 

nearly 4 million staff members.201 Colleges and universities can promote a campus walking culture by creating 

pedestrian-friendly campuses, adopting and implementing policies that support walking, promoting walking 

clubs and group events, and providing classroom instruction.

Walkable campus strategies help students, faculty, and staff members adopt active living behaviors on 

campus.215 Leaders of the campus community can work together on strategies to address environmental 

factors that influence active living and walkability challenges, such as long distances between buildings and 

bus stops, lack of sidewalks, and safety concerns associated with vehicle traffic. They can also work together 

to redesign the campus to ensure that common destinations, such as libraries and bookstores, are within 

walking distance of campus housing and lecture halls.
22

Colleges and universities can also educate and train future professionals to recognize their role in promoting 

walking and walkable communities for people of all ages. This training can be directed to students in health 

disciplines (such as health care and public health), as well as to students in other relevant fields (such as 

architecture, transportation, urban design, and business).

Worksites

Almost 150 million U.S. adults participate in the labor force.216 Many adults spend a significant amount of 

the day at a workplace—an average of 7.6 hours on a workday in 2013.103 Worksites can encourage physical 

activity and walking through a multilevel approach.217

Worksites can offer employees physical access to opportunities and supports for physical activity, including 

walking. Providing access to on-site facilities (e.g., gyms, locker rooms, showers) or to employer-subsidized, 

off-site exercise facilities is associated with physical activity among employees.218,219 The use of active 

workstations, such as treadmill desks or workstations that encourage short periods of activity, have been 

shown to reduce sedentary behavior220,221 and increase walking during office hours.222 However, access to 

walking opportunities by itself may not be sufficient to motivate employees to walk more; informational 

outreach to support these opportunities can help promote use.161

Worksites can also adopt policies that enhance physical activity opportunities. For example, one study found 

that permitting physical activity during paid work hours combined with education or free access to an on-site 

gym increased physical activity.223 A meta-analysis reported that offering worksite physical activity programs 

during company-paid time resulted in larger improvements in physical fitness than programs offered outside 

company-paid time.224 Paid activity breaks have also been associated with improved employee perceptions 

of productivity.225
23

Incorporating short periods of physical activity into the workday routine has shown modest but consistent 

benefits in increasing physical activity in the workplace.226 Several groups, such as the National Coalition for 

Promoting Physical Activity and the American Council on Exercise, have promoted policies that include brief 

activity breaks, flexible schedules, and walking meetings as potential strategies to increase participation in 

worksite physical activity.227-229

Worksite health promotion programs can also promote physical activity and walking. These programs can 

conduct health risk appraisals for employees that include a physical activity assessment. When combined 

with feedback and education, these assessments can be effective in increasing physical activity among 

employees.230,231 Studies have also shown that health promotion teams or committees that represent 

employees can help employers develop, implement, and sustain worksite efforts.229,232,233 Worksite health 

promotion programs designed to promote walking can include individually-adapted health behavior change 

programs as one component.161

Worksite health promotion programs should include ways to support and sustain employee participation. 

Incentives and rewards, such as employee recognition and free water bottles, pedometers, and T-shirts, can 

be used to encourage employees’ interest and participation in physical activity programs.229 Social support 

programs can also be used at the worksite.161 For example, worksites can set up walking clubs or buddy 

systems for groups of employees to walk together during breaks or lunch.

Volunteer and Nonprofit Organizations 

The United States has 2.3 million nonprofit organizations,234 including those that work to address the needs 

of underserved populations or people with special needs. The volunteer and nonprofit sector encompasses 

a vast diversity of organizations across the country that differ in size, mission, and reach. Volunteer and 

nonprofit groups can provide access to facilities, programs, and information to promote walking. For example, 

they can open their facilities and walking programs to the wider community for free or at low cost, or they 

can organize social support programs. Organizations with facilities can link with evidence-based programs 

that are tailored to particular groups, such as minority populations or people with mobility limitations (e.g., 

GirlTrek, Walk With Ease),235,236 to offer free or low-cost walking programs.

Because of their reach and the trusted relationship that volunteer and nonprofit organizations have with their 

members, these organizations can serve as messengers to share information about the benefits of walking 

and walking programs and ways to improve walkability. For example, pedestrian safety groups can provide 

valuable information, expertise, and support for best practices that can help enhance access to safe locations 

for walking. Conservation and environmental groups can develop and share educational programs that teach 

people how to make the environment walkable and livable.

Health Care 

Health care professionals include people working in medicine, nursing, chiropractic, social work, mental 

health, nutrition, occupational therapy, and physical therapy, as well as allied health personnel, such as 

community health workers. A large proportion of people have contact with a health care professional each 

year. In 2012, almost 80% of U.S. adults visited a health care professional sometime in the past 12 months,9

and 75% of all children had contact with a health professional at sometime in the past 6 months.237

Professional organizations and recommendations from the U.S. Preventive Services Task Force (USPSTF) 

indicate that health care professionals have a role to play in counseling their patients about physical activity. 

Walking is an especially good activity for health care professionals to promote because most of their patients 
24

can walk, and walking can be easily modified to a 

person’s abilities. Professional organizations, such 

as the American College of Preventive Medicine238

and the American Academy of Pediatrics,239

encourage counseling as part of routine care for 

patients.

The USPSTF recommends behavioral counseling 

for adults who are overweight or obese and 

who have additional cardiovascular disease risk 

factors,240,241 as well as for anyone aged 6 years 

or older who screens positive for obesity.242,243

Physical activity is an integral component of 

these moderate to highly intensive behavioral 

interventions. Although the USPSTF does not 

recommend that clinicians offer intensive 

behavioral counseling related to physical 

activity to all patients, it does recommend that 

clinicians selectively counsel patients on the 

basis of their professional judgment and patient 

preferences.244-246

Health care professionals who want to counsel 

patients about physical activity have several 

challenges, including limited time; reimbursement 

issues; lack of practical tools; and insufficient 

knowledge, skills, and confidence that counseling is effective.247-249 Additional training and education for 

health care professionals about the importance of physical activity and how to help patients formulate a 

physical activity plan may help overcome some challenges. Health care professionals can also access existing 

tools and guides to help them counsel their patients about physical activity.239,250 In addition, they can review 

resources specifically designed to help them discuss physical activity with patients with chronic conditions 

or disabilities.250-252 Finally, programs such as Exercise is Medicine recommend that health care professionals 

write prescriptions for physical activity and provide information on local resources and support systems.250

These efforts can include referring patients to certified exercise professionals to oversee their exercise 

program.250

Media

Media outlets include mass media (e.g., television, radio, outdoor advertising), small media (e.g., brochures, 

posters), and social media (e.g., Facebook, Twitter, Pinterest, blogs). Each month, 287 million people watch 

television and 204 million use a computer to access the Internet.253

The media can be effective in influencing attitudes and changing behaviors, including health behaviors.254-257

However, evidence on the effectiveness of stand-alone mass media campaigns to increase physical activity 

is inconsistent.161,258,259 According to the Community Preventive Services Task Force, insufficient evidence 

exists to determine the effectiveness of stand-alone mass media campaigns to increase physical activity 

at the population level.161,258,259 However, media campaigns have been part of effective multicomponent 

interventions. Mass media education campaigns, combined with other intervention strategies, were effective 

in increasing physical activity among adolescents260 and walking among adults.261,262
25

Public Health

Public health focuses on protecting the health of entire populations and population sectors in locations 

ranging from local neighborhoods to entire countries and regions of the world.263 Public health professionals 

often work in federal, state, or local governments.264 In their efforts to promote population health, they 

typically partner with other groups and organizations, such as departments of transportation, health care 

professionals, academic institutions, public safety agencies, local planning agencies, human service and 

charity organizations, education and youth development organizations, recreational and arts organizations, 

economic and philanthropic organizations, and environmental agencies and organizations.265,266

Public health professionals conduct research and evaluate programs to determine what works to promote 

and sustain physical activity, including walking. They can summarize findings about what community 

approaches work to increase walking and walkability. These findings and related recommendations can be 

used by other sectors of society to plan and implement interventions.

In addition to identifying evidence-based strategies, public health professionals can help other sectors design 

and implement interventions.265 They can convene partners across multiple sectors to learn from each other 

and to develop strategic action plans that efficiently use each partner’s expertise and resources. Public health 

professionals at federal, tribal, state, and local levels can share best practices and tools and provide technical 

assistance, training, and funding. 

Public health professionals also collect data about walking and walkability to measure and monitor changes 

over time. They can assess and monitor pedestrian behaviors and environmental features that influence 

pedestrian safety. These data are important in the planning and evaluation of programs to support safe 

walking and promote walkability.
26

Gaps in Surveillance, 

Research, and Evaluation

Existing research provides an evidence base about what works to increase walking in the United States. 

However, additional surveillance, research, and evaluation work is needed to maximize the success of 

community approaches and address disparities in walking and walkability. Lack of economic analyses is a gap 

across both research and evaluation. This section identifies major gaps in what is currently known.

Surveillance

Public health surveillance is the ongoing, systematic collection and use of health data to plan, implement, and 

evaluate public health practice.267 It provides data to monitor health behaviors and environmental and policy 

supports over time. These data can also be used to support decisions about how to allocate resources and to 

evaluate the effect of various programs and interventions.

Walking

Walking among adults is assessed through self-report in several surveillance systems, such as the Behavioral 

Risk Factor Surveillance System,84 the National Health Interview Survey (NHIS),87 and the National Household 

Travel Survey.86 However, these systems collect data in different ways, which can make comparisons difficult. 

For example, the NHIS Cancer Control Supplement collects information on the number of minutes that people 

walk,87 whereas the National Household Travel Survey collects information on the number of trips made by 

walking.268 Systems also vary in the type of walking assessed—whether for leisure84,87 or for transportation.268

Walking data at the community level are available for selected geographic areas that are part of larger state 

systems and have a sufficient number of survey respondents to produce stable estimates.269 Improvements to 

existing surveillance systems are needed to establish standard and valid measures of walking that can be used 

across systems at national, state, regional, and local levels.

Surveillance systems that assess walking among children and adolescents mainly collect data on walking for 

transportation. For school-aged youth, walking for transportation is systematically monitored at national and 

state levels and in selected localities with populations of more than 1 million people.86,270,271 The National 

Youth Physical Activity and Nutrition Survey assessed walking in a national sample of high school students in 

2010,85 but this survey has not been repeated. 

The number of people who walk on public streets can be monitored through counts of pedestrians.111,272,273

Traditionally, these numbers have been collected manually. However, continuous monitoring programs are 

more likely to use electronic methods, such as infrared counters and video or laser counting technology.272

A continuously emerging field is the development of methods that can supplement data from these devices 

with information from wireless devices and cell phone networks. Although pedestrian counts may help 

researchers conduct surveillance of a local transportation corridor or a sample of corridors, no standard 

method exists to collect these counts.111 Methods that use pedestrian counts as part of national surveillance 

will also require further research on the best ways to compile and analyze these data.
27

Walkability

A walkable community is one where it is safe and easy to walk and where pedestrian activity is encouraged.11

Conducting surveillance of walkability in the United States can be challenging. No single measure exists to 

measure walkability because it is defined by many local features. These features, however, can be measured 

and monitored. Examples of local neighborhood features include attractive scenery, convenient places to 

walk to (such as shops and restaurants), and safety features (such as street lighting).127,134,274 Other examples 

of features that can be monitored, particularly for wheelchair rolling, include the condition of routes, such as 

sidewalks, in terms of surface condition, slope, and other barriers.275

No national surveillance system routinely and comprehensively monitors local neighborhood features of a 

walkable community. Some indicators of walkability are compiled in current databases and available at the 

Census Block Group level. A Census Block Group is a cluster of blocks, which is the smallest geographical 

entity for which census data are tabulated.276,277 Environmental features of a walkable community—such as 

residential and employment density, land use diversity, access to destinations, and distance to transit—are 

available at the Census Block Group level in a database available from the U.S. Environmental Protection 

Agency.278 A database available from the U.S. Department of Housing and Urban Development contains a 

calculated feature of walkability—neighborhood block density—and combines it with data on housing and 

transportation affordability at the Census Block Group level.279,280

Questionnaires and on-the-ground audits are the main tools used to directly assess features of community 

walkability. However, questions about walkability have not been included as routine core components of any 

national surveillance system. Some features of walkable communities have been assessed on topic-specific 

surveys or survey supplements.117,281 For example, the 2012 National Survey of Bicyclist and Pedestrian 

Attitudes and Behavior assessed the presence of sidewalks and perceptions of safety.117 The 2015 NHIS Cancer 

Photo courtesy of www.pedbikeimages.org/Dan Burden
28

Control Supplement is assessing the presence of places to walk (e.g., paths, sidewalks), the presence of places 

to walk to (e.g., shops, public transit, houses of worship), and perceptions about neighborhood safety.281

In addition, several validated self-report questionnaires282 can assess the perceived characteristics of the 

environment associated with physical activity. However, the length of most of these questionnaires precludes 

them from being considered for existing surveillance systems, where survey time is often limited. Although 

questionnaires with 7 or 9 items exist,281,283 shorter questionnaires are needed to increase the feasibility of 

routinely assessing key features of the environment as part of core questions in surveillance systems.

On-the-ground audits of environmental supports can be used to examine the presence (or absence) 

of features that support walking, such as the presence and quality of parks, recreational facilities, and 

sidewalks.282 Although several on-the-ground audit instruments exist, consistent evidence on which aspects of 

the environment should be examined is lacking. These types of audits are also difficult to conduct on a wide 

scale and therefore may be limited as surveillance tools. Narrowing their focus may improve their feasibility 

for surveillance use.

As audit tools are piloted in states and cities, additional information can be collected on their feasibility 

as surveillance tools. For example, in 2014, a multimodal collaboration led by the Federal Highway 

Administration, the Federal Transit Administration, the National Highway Traffic Administration, the Federal 

Railroad Administration, and the Federal Motor Carrier Association was initiated to conduct at least one walk/

bike road safety assessment in every state.284 Findings from this project can provide further information in this 

area. In addition, future research should examine the use of technological approaches that provide images of 

neighborhood walkability features. For example, techniques such as imagery-based geographic mapping may 

help reduce the time and cost of conducting on-the-ground audits of walkability.285-289

To connect behavior to walkability and other measures of the built environment, location data from diverse 

sources (e.g., health studies, surveillance systems) need to be geographically coded (or “geocoded”). 

Currently, national surveys—such as the National Health and Nutrition Examination Survey, the NHIS, and 

the National Household Travel Survey—collect residential address data, and these data have been geocoded 

for analyses in restricted data centers. However, residential address data do not adequately capture where 

most physical activity takes place.290,291 To better characterize environmental influences on walking and 

physical activity, continued data integration is needed. More data are needed to identify the places where 

people are active—known as “activity spaces”—and the extent to which these activity spaces influence 

walking.290,291 Surveillance data can support the research needed to determine the interrelationships 

between activity spaces, physical activity levels, and pedestrian safety (e.g., traffic exposure, rates of 

collisions involving pedestrians).

Surveillance of supports for walking and walkability are especially needed at worksites and schools, where 

adults and children spend much of their time. No national surveillance system currently monitors walking or 

physical activity supports in the workplace, although worksite physical activity is a national health objective.14

The most recent estimates available are from the 2004 National Worksite Health Promotion Survey, which 

estimated that only 19.6% of worksites offered a physical activity program.292 For schools, some data on 

walking supports, such as state guidance on policies related to shared use and walking to and from school, 

are collected.106 However, more specific information about these policies and how they are implemented 

is needed.
29

Research

Research is needed to identify and advance the most effective approaches to increase walking and to 

understand how effectiveness varies on the basis of community characteristics. In particular, strategies that 

increase walking in communities or population subgroups with low levels of physical activity need to be 

identified. For example, for older adults, research is needed to identify barriers to walking, determine why 

these barriers exist, and develop specific strategies to increase walking in this population.72

Research is also needed to examine the relationship between increased walking and the risk of pedestrian 

injury. One study suggested that the risk of pedestrians being hit by motor vehicles is lower when more 

people walk,293 but this relationship might depend on many other factors. Although many factors have been 

found to influence pedestrian risk,294 additional research is needed to systematically assess and monitor these 

factors, including vehicle characteristics (e.g., electric or combustion engine),295 pedestrian characteristics, 

driver and pedestrian behaviors, and environmental characteristics.296,297

Existing research demonstrates that broadly defined or multicomponent approaches increase physical 

activity,155,161,163 but it is rarely known which set of individual elements are most effective, necessary, or 

sufficient to achieve a positive effect while minimizing any negative effects, such as injuries. For example, 

street design is one way to encourage safe walking,155 but which elements (e.g., improved street lighting, 

landscaping, features to slow vehicle speed) are most important is unclear. 

Effective communication can be a way to increase the likelihood that individuals, families, and other 

social groups will participate in programs or use particular locations to walk.161 The combined approach of 

increasing opportunities or places to be physically active and conducting informational outreach has been 

shown to increase physical activity, including walking.153,154,161 However, researchers are not sure which specific 

messages or combination of messages and other intervention components, such as walking programs and 

access to places to walk, are best for populations that vary in age, location, race/ethnicity, and socioeconomic 

status. 

Recently, several wearable devices that track physical activity patterns have been introduced to the market, 

with the idea that devices can educate and motivate people to be more active.298 Wearable devices may need 

to be combined with other strategies to promote health behavior change.298 Research is needed to determine 

the most effective behavioral change strategies to pair with these devices.298

Conducting research into environmental approaches to promote physical activity can be challenging. 

Incorporating true experimental designs, such as randomly assigning people to neighborhoods and 

following them over time, is not practical.163 However, researchers in this area can take advantage of natural 

experiments in communities where environmental changes are planned.163,299 They can also capitalize on 

existing community models that are successful in increasing access and opportunities to be physically active 

and determine how these models differ from those that are less successful.

A collaborative research agenda that identifies the most important research questions could maximize 

the use of limited resources. Collaborators would include partners in transportation, community design, 

environmental health, physical activity and public health practice, and academic research. Stakeholders who 

would likely use the resulting data, such as decision makers and advocacy groups, should also be part of 

developing the research agenda. 
30

Evaluation

Communities across the country are implementing a variety of interventions that promote walking, but many 

of these interventions are not being adequately evaluated. Evaluations are necessary because they can help 

decision makers identify and correct problems before, during, and after implementation; assess whether an 

intervention is working; determine the cost-effectiveness of an intervention; justify the continued existence 

of an intervention; and inform other interested communities about successes and challenges. Plans for 

evaluation should be incorporated early in the development process so that critical questions are identified 

by stakeholders, appropriate data are collected, adequate resources are allocated, and results are shared in a 

way most useful to stakeholders.300 Tools such as the CDC Framework for Program Evaluation are available to 

help programs with the evaluation process.300

Evaluation data would be strengthened by the use of common metrics across studies to allow comparison 

of the relative cost and effectiveness of various interventions. Communities need tools and protocols to 

measure cost, equity, and behavioral and health outcomes (including injury data) reliably and consistently. 

They also need help comparing how local programs were implemented against how the original program 

was designed.

Evaluations of interventions designed to promote walking should include a pedestrian injury component to 

ensure that increased walking does not have detrimental effects on pedestrian safety. Likewise, evaluations 

of traffic safety interventions should address the effectiveness of the intervention to support walking. An 

interdisciplinary approach that includes evidence and input from city planners, community groups, and public 

health and engineering professionals can lead to productive solutions that increase walking and ensure safety. 

Economic Analysis 

Estimating the economic cost of inadequate levels of physical activity in the United States and the costs 

of initiatives to increase those levels can help policy makers justify health program decisions. Studies 

have provided national estimates of the health care expenditures associated with lower levels of physical 

activity.76,78 Future research could develop national estimates to quantify additional economic costs,301 such 

as lost productivity from premature death and disability associated with illness and lower worker productivity.

The economic risks and benefits of physical activity and of walking initiatives, programs, and policy efforts 

are needed to guide decisions about resource allocation and program efforts. A recent review concluded 

that improving opportunities for walking and biking seemed to be a cost-effective way to increase physical 

activity.302 However, the available evidence was limited to a small number of studies.302 Future interventions 

to promote physical activity should collect data (e.g., on resources used, costs, effects) to support economic 

analyses.302,303

Studies that examine the cost-effectiveness of physical activity interventions usually focus on the healthrelated benefits associated with changes in physical activity. Calculations of the economic benefits of 

these interventions may need to include other potentially quantifiable savings that result from changes in 

environmental design or program implementation.304-306 Although some benefits (such as increased social 

interaction) may be difficult to directly quantify in economic terms, studies have quantified economic benefits 

related to factors such as fuel savings307 and reduced air pollution.308 For example, when two studies included 

additional benefits, they found that the economic benefits of community design change to promote physical 

activity outweighed the cost.307,308 Future research should explore how to best quantify and include these 

additional benefits in the economic evaluation of programs designed to promote physical activity. 
31

The Call to Action

This section presents five goals, with related strategies 

to support walking and walkability in the United States. 

Implementation of these strategies will not only make it 

easier and safer for people to walk, but many of these 

strategies will also make it easier and safer for people of 

all ages and abilities to use a wheelchair, ride a bike, and 

be active in other ways. To achieve these goals, we will 

need to work together across many sectors of society, 

including transportation, land use, and community 

design; parks, recreation, and fitness; education; 

business and industry; volunteer and nonprofit; health 

care; media; and public health.20 Collaborative work is 

needed to amplify and extend existing efforts, as well 

as to undertake new initiatives to support these goals. 

Families and individuals will also need to be involved to 

make the United States a walkable nation.

Goal 1. Make Walking a 

National Priority 

Everyone has a role to play to make walking a national 

priority. To make more communities walkable and help 

more people walk enough to reap health benefits, we 

need increased collaboration within and across sectors, 

such as transportation, community planning, and public 

health. Resources and supports, financial and otherwise, 

will be needed for this effort. Partner engagement 

and mobilization at national, state, tribal, territorial, 

and local levels can help to forge a national walking 

movement.

Strategy 1A. Encourage people to promote walking and make their 

communities more walkable.

Walking regularly with friends, family members, and others can motivate other people to walk more. People 

can build relationships and encourage walking by forming or joining walking groups and by offering to create 

opportunities for walking, such as a walking program in a local mall309 or a neighborhood walk-to-school 

program.165

People can help make their communities more walkable in a variety of ways. They can volunteer to clean up 

places where people walk or organize group cleanup efforts in their neighborhoods. They can also support 

the use of violence prevention programs310 to improve the safety of neighborhoods.
32

People can join citizen advisory boards that try to improve safety by modifying environments, such as 

making intersections and crosswalks safer, improving lighting, increasing visibility for walking, and improving 

enforcement of traffic laws. Individuals and groups can also participate in community and transportation 

planning processes at regional or local levels to encourage plans and policies that promote walk-friendly 

environments.

A variety of resources, including users’ guides, workbooks, manuals, action guides, and tool kits, can help 

people who want to improve walking and walkability in their communities.311-317 These resources offer 

guidance related to messaging, participation in local planning efforts that identify best sites for walking 

paths and sidewalks, promotion of community trail development and its use among youth and adults, 

implementation or advocacy of programs that close streets to automobile traffic on designated days, and 

collaboration with the broader community to mobilize groups with shared interests to support walking.311-317

People can promote walking and walkability in their neighborhoods and communities by doing the following:

■ Walk with friends, family, and work colleagues on a regular basis.

■ Participate in organized activities, such as joining a walking group or leading a walk-to-school program.

■ Join or help mobilize a cleanup effort to make places where people walk safe and attractive.

■ Participate in community activities to reduce crime and violence.

■ Join advisory boards, nonprofits, and community planning processes to support safe and convenient 

places to walk. 

Strategy 1B. Create a walking movement to make walking and 

walkability a national priority. 

Several national efforts already support walking, physical activity, and improved places to walk and be active, 

including the National Physical Activity Plan,

20 Designed to Move,318 Partnership for Active Transportation,319

Convergence Partnership,320 and Every Body Walk!321 Working individually and together, these groups are 

creating a movement to improve walking and walkability. Similarly, many federal efforts support strategies that 

can improve walking (e.g., the National Prevention Strategy;

12 Safer People, Safer Streets initiative;17 Let’s Move!

campaign;15 Go4Life campaign;16 Partnership for Sustainable Communities19).By agreeing on goals and objectives 

for a national walking movement, these groups could amplify the impact of their efforts. In addition, creating a 

federal interagency workgroup or leveraging existing workgroups to focus on walking could help establish and 

sustain a successful national walking movement.

Opportunities to walk and create safe, easy, and attractive places to walk will require cross-sector collaboration at state and local levels. Transportation planners and local or state organizations with health-related 

missions should work together to add health as a goal in planning.322,323 At federal, tribal, state, and local 

levels, the public health sector can also play a role in forming and convening partnerships. These partnerships 

can link people to services; mobilize community and cross-sector coalitions; share best practices; develop and 

disseminate tools and resources; conduct community-wide campaigns; and provide financial and technical 

assistance to worksites, schools, and communities to promote physical activity among people of all abilities. 

Professionals and leaders from all sectors can champion communities that are safe and walkable for all users. 

For example, pediatricians can champion safe routes for physical activity opportunities, including walking or 

biking to school.324
33

Organizations with facilities (e.g., faith-based organizations, YMCAs, parks and recreation departments, senior 

centers) can link with programs that are tailored to particular communities, such as underserved groups or 

people with mobility limitations, to offer walking programs. Pairing community volunteer groups—such as 

connecting older adults with local school district volunteers to walk with children to and from school—can 

offer walking opportunities across generations.

All sectors of society, including transportation, community design, education, business, nonprofit, parks and 

recreation, health care, public health, and the media, can work together to make walking a national priority. 

These sectors can do the following:

■ Build on existing national plans and collaborations to make walking a national priority. 

■ Create a federal interagency workgroup or leverage existing workgroups to focus on creating safe, 

easy, and attractive opportunities to walk. 

■ Compile and synthesize existing tool kits and make them easily available to meet specific community 

needs.

■ Convene and support state and local partnerships between sectors that promote walking and 

walkability.

■ Link organizations and programs to ensure that underserved groups and people with disabilities have 

opportunities to walk.

Goal 2. Design Communities that Make It Safe and Easy to 

Walk for People of All Ages and Abilities

People should be able to walk almost anywhere. Designing communities to encourage pedestrian activity 

will make it safer and easier for all users, including those with mobility limitations and other disabilities. 

Supportive design can be implemented in large and small communities in diverse geographic areas.

Strategy 2A. Design and maintain streets and sidewalks so that walking 

is safe and easy.

Streets can be designed to provide safe and 

easy places that encourage walking.157,158 They 

can include sidewalks; provide space for people 

to walk, use wheelchairs, bike, and drive; and 

use trees, curbs, or physical space to separate 

pedestrians from bicyclists and motor vehicles. 

Traffic safety can be enhanced by using design 

features that decrease vehicle speeds (e.g., 

speed humps, reduced speed zones, signal 

modifications) and increase the number of safe 

pedestrian crossings (e.g., medians, pedestrian 

crossing islands).90,159,325 Technical guidance 

and specific information related to the design 

of walkable urban thoroughfares has been 

published by the Institute for Transportation 

Engineers.326
34

Making streets safer and easier for people who walk also makes them safer and easier to use for people of all 

ages and abilities, including those who use wheelchairs and walkers.327 In addition, sidewalks and streets can 

be designed to specifically address barriers for people with disabilities. Examples include using ADA curb cuts 

to improve accessibility for people with mobility limitations or those who use assistive devices and audible 

traffic signals for people with vision impairments. Communities should ensure that all sidewalks have a plan 

for upgrades to comply with the ADA, as required by the U.S. Department of Justice.328,329

Regular maintenance of sidewalk quality and safety can increase their use. Sidewalks with cracks, holes, 

or uneven surfaces pose tripping hazards. Other hazards, such as overgrown vegetation, storm runoff, or 

unplowed snow, may force pedestrians into high-speed traffic. Keeping sidewalks free from hazards is an 

important long-term commitment for the safety of those who use them. Particular attention should be 

given to maintenance of sidewalks in low-income and minority communities, where some sidewalks may be 

more likely to be of lower quality.330 The appeal of sidewalks can also be improved through the use of street 

lighting and landscaping (e.g., street trees, planters).174 The special needs of older pedestrians should also be 

considered; features such as benches and traffic islands that account for slower walking paces and reduced 

agility can be added.331

Community planners and designers, community stakeholders, transportation professionals, and government 

agencies can encourage walk-friendly environments by doing the following: 

■ Design streets, sidewalks, and crosswalks that encourage walking for people of all ages and abilities.

■ Improve traffic safety on streets and sidewalks.

■ Keep existing sidewalks and other places to walk free from hazards.

Photo courtesy of www.pedbikeimages.org/Julia Diana
35

Strategy 2B. Design communities that support safe and easy places for 

people to walk.

Walkable communities can be created through many community design principles and supportive policies. 

Community design should encourage developers to build residences, worksites, schools, parks, businesses, 

shopping districts, public transit systems, and health care facilities within walking distance of each other.332,333

Community design can also ensure that streets are well-connected, blocks are not too long, and pedestrians 

can choose from several alternative routes.121,127,134 Alternative routes can allow pedestrians to avoid heavily 

trafficked roads that are less safe to cross and are a source of exposure to air pollution. Communities can 

adopt policies, such as Complete Streets,158,175,176 that support the routine design and operation of streets that 

are safe for all pedestrians regardless of age, ability, or mode of transport.

Another way to make walking easier is to support a well-maintained public transit system that is within easy 

walking distance of residences, worksites, and shopping and entertainment destinations in communities 

where development patterns have made public transit financially feasible.130,160 Public transit should be safe, 

efficient, and easy to use for all users, including people with disabilities. Building walkable communities 

around transit hubs can further encourage walking.180,181

Communities can improve safety for pedestrians through design features and traffic laws.91,294 Reducing 

vehicle speeds where people walk can improve safety.334 Beyond physical design features of streets to 

decrease vehicle speed, states and localities can enforce existing speed limits and consider policies that 

reduce speed limits where many people walk.325 Policies intended to reduce other types of risky driving, such 

as alcohol-impaired driving,335 can also be enacted.

Communities can also support walking and other outdoor physical activities by implementing and maintaining 

design features that reduce opportunities for crime and violence and promote a sense of ownership and 

safety. For example, efforts to clean, plan, and maintain vacant lots have been associated with reductions in 

violence and crime.336 In addition, fewer crimes are committed on streets that are appropriately lighted and in 

clear view of windows.91

Community planners and designers, transportation professionals, community stakeholders, public health 

professionals, and government agencies can design safe, easy, and attractive places to walk by doing the 

following:

■ Adopt community planning, land use, development, and zoning policies and plans that support 

walking for people of all ages and abilities.

■ Locate schools, worksites, businesses, parks, recreational facilities, and other places that people 

regularly use within walkable distance of each other.

■ Support crime and violence prevention through environmental design and maintenance.

■ Reduce speed limits and enforce traffic laws in areas where walking is common.

■ Support safe, efficient, and easy-to-use public transit systems and transit-oriented development.
36

Goal 3. Promote Programs and Policies to Support Walking 

Where People Live, Learn, Work, and Play

Walking is easiest when it is built into everyday activities and locations where people spend their time. 

Two locations that may be especially important are schools and worksites, where youth and adults spend 

much of their time. Other community locations and organizations—such as colleges and universities, faithbased organizations, health clubs and fitness facilities, parks, recreational centers, nonprofit organizations, 

community organizations, shopping malls, and senior centers—can also help promote walking through their 

facilities, programs, and policies.

Strategy 3A. Promote programs and policies that make it easy for 

students to walk before, during, and after school.

Making it safe and easy for students to walk before, during, and after school can create opportunities for 

youth to get some, if not all, of the recommended amount of daily physical activity on school days. Schools 

can provide opportunities to be physically active before, during, and after school, such as walk-to-school 

programs, walking clubs, physical education, recess, and physical activity breaks. Teachers and program 

leaders can promote and ensure inclusion of all students by modifying physical education and other school 

programs for students who have disabilities or chronic health conditions.337

Photo courtesy of www.pedbikeimages.org/Dan Burden
37

Schools can increase access to safe places for students and their families to be active by establishing safe 

routes to after-school activities and negotiating shared use agreements with local parks and recreation 

departments, Boys & Girls Clubs, YMCAs, or other community organizations and locations. School wellness 

committees (which include teachers, parents, and community members) should be involved in school walking 

efforts, and school district wellness policies are important sources of support for these activities.

Strategies that increase walking in school settings have the potential to affect a significant number of adults 

as well. Schools are a worksite for millions of teachers, administrators, and staff members.201 In addition, 

schools can increase walking among community residents through formal shared use agreements that 

make school gyms, playgrounds, sport fields, and tracks available after school, on weekends, and during 

the summer.210,338

Schools can increase walking by doing the following:

■ Implement Safe Routes to School or similar walk-to-school programs. 

■ Provide daily physical education for students in grades K–12 and daily recess for elementary students.

■ Encourage walking opportunities for students and staff as part of regular classroom activities.

■ Make gyms, fields, and tracks available before, during, and after school for students and staff and 

encourage their use through activities such as walking and fitness clubs and other school-related 

events.

■ Establish formal policies or agreements, such as shared use agreements, to make school facilities 

available to community residents or to allow schools to use nearby community facilities, such as fields 

and parks.

Strategy 3B. Promote worksite programs and policies that support 

walking and walkability.

Worksites can implement worksite health promotion programs that can improve the health of their 

employees and their bottom line.339,340 As part of these efforts, worksites can provide places to walk and 

implement programs and policies that encourage and support walking. 

Worksites with sufficient resources can provide on-site equipment and facilities for walking, such as 

treadmills, changing areas, and showers. However, lower-cost options—such as promoting walking meetings, 

walking breaks, and the use of stairs and nearby trails, paths, or walking loops—can be used by most 

worksites. Employers can also provide maps of nearby walking routes and information about places to walk 

indoors during inclement weather.

In addition, worksites can provide access to places to walk, and they can implement programs and policies 

that make it possible for employees to walk and be physically active.219 Worksite policies that encourage brief 

activity breaks, flexible schedules, and walking meetings have been identified by several groups as potential 

strategies that can support employees’ efforts to be active.227-229 Incentives, such as free activity trackers or 

partial subsidies for off-site gym memberships, can help employees meet and sustain their personal physical 

activity goals. Employers can support the use of health risk appraisals that include feedback and education, 

individually-adapted health behavior change programs, or social support programs.217,230,231
38

Employers can also incorporate approaches that integrate occupational safety and health protection with 

health promotion programs (e.g., Total Worker Health341). These approaches could promote physical activity 

as a way to help prevent worker injury and illness and advance health and well-being. Worksites should 

also ensure that their programs consider employees with functional limitations and disabilities and offer 

incentives that accommodate employees regardless of abilities, work shifts, or location.229

Finally, walkability and access to public transit are important factors for businesses to consider when selecting 

new worksite locations. Economic development professionals can help employers look for locations in 

walkable communities. In established locations, senior business leaders can look for ways to participate in 

local planning discussions that seek to make the surrounding community more walkable. Employers can also 

be influential and effective advocates for more walkable communities, which benefit their employees and the 

entire community.

Employers can increase walking by doing the following:

■ Provide access to facilities, locations, and programs to support walking. 

■ Use policies and incentives to encourage walking, such as flextime, paid activity breaks, or discounts 

for off-site exercise facilities.

■ Establish walking clubs or competitions that encourage and motivate employees to meet individual or 

team goals.

■ Consider walkability and access to public transit when selecting new worksite locations. 

■ Engage in community planning efforts to make the communities around worksites more walkable.

Strategy 3C. Promote community programs and policies that make it safe 

and easy for residents to walk. 

In addition to schools and worksites, other community locations and organizations can also play a role 

in promoting and supporting walking. These include colleges and universities, faith-based organizations, 

health clubs and fitness facilities, recreational facilities, parks, shopping malls, nonprofit organizations, and 

community organizations, such as YMCAs, Boys & Girls Clubs, and senior centers. To foster the use of these 

locations by people with disabilities, communities should ensure that locations meet ADA design standards118

and work to enhance and maintain locations that are safe and accessible for all users. Ensuring safe routes to 

locations can further improve accessibility and encourage walking to locations.197

Locations and organizations can provide access to safe places—such as walking trails, indoor facilities, parks, 

and playgrounds—where walking can be separated from busy streets. For example, colleges and universities 

can create pedestrian streets and walkways that provide all users a safe place to walk. For older adults, 

readily available locations for walking, such as shopping malls and walking paths in retirement communities, 

provide safe opportunities for walking.331 Malls can be attractive places for walking, especially for middleaged and older adults, because features such as safe and climate-controlled environments, level surfaces, 

and well-lit restrooms can help overcome some barriers to walking.309

Organizations can also provide access to walking programs that accommodate a range of interests and 

abilities and help users overcome barriers to participation. Removing barriers may be particularly effective 

for less active groups. Organizations can offer programs that are specifically designed for people who may 

be concerned about how to safely be physically active, such as people with arthritis.56,149,236 For people 

with mental health conditions, peer-to-peer support programs for whole health wellness can include such 
39

activities as walking groups and sharing of information 

on how to find community walking spaces that are 

free or low cost and accessible.342 People for whom 

cost may be a barrier to participation also need 

affordable options for physical activity.343 In addition, 

organizations that integrate informational outreach or 

social support into their walking programs may be able 

to increase participation.

Community locations and organizations can increase 

walking by doing the following:

■ Provide safe and convenient access for all users 

to community locations that support walking, 

such as walking trails, parks, recreational 

facilities, and college campuses.

■ Offer walking programs that address barriers, 

including physical limitations and safety 

concerns.

■ Promote the availability of safe, convenient, 

and well-designed community locations and 

programs that promote walking.

■ Offer evidence-based walking programs that 

are free or low cost.

■ Set up walking groups, buddy systems, and 

other forms of social support for walking 

that provide multiple opportunities to walk 

each week.

Goal 4. Provide Information to Encourage Walking and 

Improve Walkability 

Easy-to-understand and relevant information about how walking can provide substantial health benefits 

can motivate people to walk. To complement health information, local groups can help increase awareness 

about safe and accessible places to walk in the community. This information is especially effective when it 

is tailored to individual needs and used in conjunction with community designs, programs, and policies that 

promote walking. Another way to promote walking is to train current and future professionals from a variety 

of disciplines about the importance of walking and how to promote it within their profession.

Strategy 4A. Educate people about the benefits of safe walking and 

places to walk. 

Education about the importance and benefits of physical activity and walking should be shared by a variety 

of trusted messengers. Information should be easy to understand and shared through a variety of channels. 

Special efforts should be made to reach people who are the least physically active, such as girls, older adults, 

adults with lower levels of education, and people with mobility limitations and other disabilities.9,147
40

Health care professionals can assess patients’ 

physical activity levels and educate patients 

across their lifespan about the importance 

of physical activity. They can also help their 

patients understand that walking is a good way 

to get the physical activity they need for health. 

Tracking physical activity as a key piece of health 

information can help make discussions about 

physical activity a regular part of a health care 

visit.344,345 Clinical programs, such as the Exercise 

as a Vital Sign initiative, can prompt health care 

professionals to collect and review patients’ 

physical activity levels to facilitate counseling 

and referral.346

Counseling about walking may be especially 

important for adults who are at higher risk of 

chronic disease, such as those who are overweight 

or obese and who have additional risk factors 

for cardiovascular disease.240,241 Many tools and 

resources are available to help facilitate physical 

activity counseling, such as the American Academy 

of Pediatrics’ Bright Futures guidelines and the 

Exercise is Medicine Healthcare Providers’ Action 

Guide.

239,250 Resources are also available to help 

health care professionals discuss physical activity 

with patients with disabilities.251,252

Education can take place in a variety of locations, depending on where people spend their time. Physical 

education and health education classes in schools can provide students in prekindergarten through 12th 

grade with opportunities to acquire the knowledge, attitudes, and skills necessary to integrate physical 

activities, including walking, into their daily lives.347,348 Worksites are a good place to reach employed adults. 

Educational materials and seminars can help employees learn about the benefits of walking and strategies 

for incorporating walking into their daily lives. Colleges and universities can promote walking as part of an 

active lifestyle for students, faculty, and staff. Senior centers, volunteer and nonprofit organizations, and 

health care organizations can ensure that older adults learn about the benefits of walking for their health, 

vitality, and independence. Many locations can provide easy-to-read signs and maps to encourage people to 

walk. Pedestrian safety organizations can provide valuable information, expertise, and education about best 

practices for pedestrians.294,349

Teachers and professors, health care professionals, public health professionals, employers, volunteer and 

nonprofit organizations, community organizations, and transportation departments can help educate people 

about the benefits of walking by doing the following:

■ Establish physical activity as a key health indicator tracked by health care professionals.

■ Have health care professionals offer physical activity counseling to their patients, especially those 

at high risk. 
41

■ Integrate walking and other types of physical activity into school, college, and university curricula.

■ Provide signs and maps to help people find safe places to walk and provide information on accessibility 

for people with mobility or other limitations.

■ Educate pedestrians about how to walk safely and the risks of alcohol-impaired and distracted walking.

■ Provide employees with tailored messages about walking in and around the worksite.

Strategy 4B. Develop effective and consistent messages and engage the 

media to promote walking and walkability. 

One way to reach a large number of people with information and motivational messages about walking 

is through the media. Media outlets can shape public opinion and support efforts to improve community 

walkability by spotlighting problems and solutions in compelling, credible ways. In 2012, 7 out of every 10 

people (71%) in the United States said they watched television news, read a print newspaper, or listened to 

radio news on the previous day.350 In addition to these mass media channels, social marketing interventions 

and population-specific media can reach distinct groups.351

To be most effective in increasing knowledge and awareness, media campaigns that promote walking and 

walkability should be used as part of broader community-wide campaigns.163 These campaigns can include 

individually-adapted health behavior change programs and activities, social support and self-help groups, and 

policy or environmental changes.163 Because groups within the general population receive information and 

are influenced in various ways, an effective media strategy will need to determine which messages resonate 

best with specific groups in the population and then segment, focus, and tailor appropriate messages for each 

of these groups.

Important partners for messaging and media efforts include traditional media professionals, as well as 

those who use social media channels. These partners can do the following:

■ Provide public education and awareness campaigns to promote walking and walkability and link these 

campaigns with other activities meant to increase walking.

■ Tailor campaign messages and activities to resonate with specific audiences. 

■ Use relevant communication channels (mainstream and social media and emerging technologies, such 

as walking apps and video games) to market walking and walkability.

Strategy 4C. Educate relevant professionals on how to promote walking 

and walkability through their profession.

Health care professionals, teachers, community planners, and transportation professionals can help improve 

walking and walkability when they have the knowledge and understanding about how to promote walking 

and walkability. Health care professionals should receive training to help them provide physical activity 

counseling. Schools should offer professional development training to teachers and administrators on ways to 

incorporate physical activity into regular classroom activities and throughout the school day.337,352,353

Colleges and universities are in an ideal position to educate and train future professionals to recognize their 

role in promoting walking and walkable communities to benefit people of all ages and abilities. This training 

can be directed to students in health disciplines, such as health care and public health, as well as to students 

in fields such as architecture, transportation, urban design, and business. In addition, physical activity, public 
42

health, and urban and regional planning programs can provide opportunities for students to be introduced to 

healthy community design principles during their training and to learn how to best work together to create 

and maintain walkable communities.

Interdisciplinary training through continuing education is also needed for current community planners, 

economic development professionals, and public health practitioners. Urban and regional planners will 

benefit if they are able to analyze and use physical activity and health data.322,323 Public health professionals 

need to understand the intricacies of the built environment and how to best use data resources across 

different disciplines, as well as how to work with city planners and transportation engineers.354,355

Public health professionals, health care professionals, employers, community planners, school districts, 

teachers, and academic institutions can support the training of professionals by doing the following:

■ Include information on physical activity and behavioral counseling in the training, continuing 

education, and accreditation process for all health care professionals. 

■ Provide training to administrators and classroom teachers on ways to incorporate walking throughout 

the school day.

■ Integrate walking and walkability as part of the higher education curricula across majors to promote 

interdisciplinary training.

■ Offer continuing education opportunities that promote walking and walkability for relevant 

professionals.
43

Goal 5. Fill Surveillance, Research, and Evaluation Gaps 

Related to Walking and Walkability

To increase walking and support walkable communities, decision makers need information to help them plan, 

implement, and evaluate interventions. Data can help decision makers learn who is walking, where they are 

walking, and for what purposes; what walking supports already exist in the community and what supports 

are needed; what interventions can be used to increase walking; how well these interventions work once 

implemented; and what influence these interventions have on pedestrian injuries. Data can also be used to 

determine the costs and cost benefits of interventions.

Strategy 5A. Improve the quality and consistency of surveillance data 

collected about walking and walkability.

To help with planning and evaluation, decision makers at local, state, and national levels need easy access 

to data on walking and walkability. Measures of walking and walkability should be valid and reliable across 

different data systems, settings, and research studies. Systematically collecting data on the characteristics 

of people who walk and those who do not walk, the places where people walk and why, and the reasons 

why people do not walk will help decision makers identify high-need areas for interventions and assess how 

current interventions are working.

In addition to better data on pedestrian activity and volume, many communities also need better data on 

the circumstances of vehicle crashes involving pedestrians. They also need better guidance on best practices 

for implementing pedestrian counting programs, and projects such as the Federal Highway Administration’s 

Bicycle-Pedestrian Count Technology Pilot Program are working to address these needs.284

Conducting surveillance of community walkability can be challenging. Although data resources are available 

for assessing some features of walkability (e.g., distance to transit, block density, land use diversity),278,279

no current surveillance system routinely and comprehensively monitors local neighborhood features of a 

walkable community. Additional research is needed to develop brief survey and on-the-ground audit tools 

or technological approaches that capture the most relevant aspects of walkability to measure and monitor. 

Surveillance of supports for walking and walkability may be especially important in settings where adults and 

youth spend the majority of their time, such as worksites and schools.

Partners in transportation, community design and planning, physical activity, public health, information 

technology, engineering, business, education, and academic research can work together to do the following:

■ Establish standard and valid measures of walking and expand their use in health, transportation, and 

other relevant surveillance systems at national, state, and local levels.

■ Develop feasible surveillance tools and methods to measure supports for walking in various settings, 

such as the community, worksites, and schools.

■ Collect data on pedestrian exposure and pedestrian injury through relevant national, state, and local 

surveillance systems.

■ Add measures of walkability to national, state, and local surveillance systems.

■ Make user-friendly data easily available to decision makers.
44

Strategy 5B. Address research gaps to promote walking and walkability.

Much is known about the benefits of walking, 

but less is known about the types of community 

approaches that help people walk more. More 

studies are needed to identify the individual 

elements of broadly defined multicomponent 

interventions that are most effective in improving 

walking or walkability. Studies are needed to 

determine what motivational and communication 

strategies best help people initiate and maintain 

walking. In addition, studies are needed to examine 

the relative effectiveness and cost-effectiveness 

of different types of walking interventions, 

whether these effects vary by population or setting 

characteristics, and the costs of implementing 

interventions. 

Studies are needed to explore how aspects of 

the built environment interact with community 

interventions to improve walking or walkability. 

Studies are also needed to examine the relationship 

of increased walking or improved walkability with 

the risk of pedestrian injury. Researchers can take 

advantage of data from natural experiments to 

answer some of these questions.163 In addition, data 

that link environmental and policy supports with 

walking behavior are needed to guide best practices 

for walkable communities.

Partners in transportation, community design and planning, public health, information technology, 

engineering, and academic research can work together to do the following:

■ Develop a collaborative research agenda with partners across sectors. 

■ Determine what specific aspects of community approaches are most important for improving walking 

and walkability.

■ Identify which walking interventions work best in different types of settings and communities, 

especially those in which people have low levels of physical activity.

■ Determine the relationship between increased walking and pedestrian injury risk and how other 

factors influence this relationship.

■ Determine the costs and cost benefits of walking interventions for individuals and communities.

■ Further define the links between environmental and policy supports and walking.
45

Strategy 5C. Evaluate community interventions to promote walking 

and walkability. 

Communities across the country are implementing a variety of interventions that are intended to promote 

walking, but many of these interventions are not being adequately evaluated. During program planning and 

implementation, evaluation findings can help decision makers identify and correct problems in a continuous 

improvement cycle. Ultimately, outcome evaluation results can determine whether the intervention increased 

walking and whether it was cost-effective.

Evaluation results are often needed to maintain funding and justify the continued existence of an 

intervention. When evaluation results are shared broadly, others implementing similar interventions can 

incorporate lessons learned into their own work. Results can be shared through informal networks, written 

reports, or tool kits that outline best practices for implementing an intervention.

Health and economic assessment tools can help when planning and evaluating an intervention. During 

the planning phase, health impact assessments can be used to estimate the potential health outcomes of 

an intervention before it is implemented.356,357 Economic assessment tools, such as the Health Economic 

Assessment Tool358 and the Integrated Transport and Health Impact Modelling Tool,359 can help assess the 

economic effects of policies and interventions and model the future effects of planned interventions.

Partners in transportation, community design and planning, public health, information technology, 

engineering, education, business, and academic research can work together to do the following:

■ Include plans and resources for evaluation in the intervention planning process.

■ Use real-time evaluation results to improve interventions and their implementation.

■ Include standard measures for walking, walkability, and costs in evaluations to improve the 

comparability of results.

■ Develop, improve, and use tools, such as audit tools, health impact assessments, and economic 

assessments, to enhance planning and evaluation processes. 

■ Create a clearinghouse or similar mechanism to broadly share evaluation results, best practices, and 

other tools developed as a result of evaluations.
46

Conclusion

Physical activity can help prevent and reduce the effects of serious, common, and costly chronic diseases, 

and it has many additional health benefits.7 The 2008 Physical Activity Guidelines for Americans outlines the 

amount of physical activity needed to achieve substantial health benefits.6 However, many people across the 

United States do not get enough physical activity to realize these benefits. Only one-half of all U.S. adults and 

one-quarter of all high school students meet the guideline for aerobic physical activity.9,10

Promoting walking offers a powerful public health strategy to increase physical activity. With this report, the 

U.S. Surgeon General calls on Americans to be physically active and for the nation to better support walking 

and walkability for people of all ages and abilities. To improve walking and walkability, communities need 

to be designed to make walking safer and easier; programs and policies need to be available to support and 

encourage walking; and individuals and families need to support each other to become and stay active.

Implementing this vision will not be a small task. Many partners are already involved, but more engagement 

is needed to increase the reach, breadth, and impact of these efforts. The dedication, ingenuity, skill, and 

concerted efforts of many partners across many different sectors will be required. Walking is an easy and 

inexpensive way to improve the health and well-being of all Americans. Now is the time to step it up and 

make walking a national priority.
47

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