Promoting Physical Activity In High Poverty Neighborhoods

Study Overview
=================
Brief Summary
-----------------
Encouraging greater levels of physical activity is critical to improving health among Americans, who are largely sedentary. Neighborhood parks are resources for physical activity that are available to most Americans within a couple miles of their homes, yet many residents are unaware of the programs and facilities available. Previous research indicates that park use is related to park programming and outreach. Because funding for parks is limited, low-cost interventions are needed to attract more people to parks to engage in moderate-to-vigorous physical activity. While many community-based organizations would like to invest in efforts that increase physical activity, few low-cost park programs are documented to be both scalable and cost-effective. Effective programs that can be replicated to make population-level impacts are needed. The goal of this study is to develop and test 2 low-cost community-level approaches, free exercise classes vs. a frequent user program, to promoting physical activity, singly and in combination, in 48 park settings in Los Angeles low-income neighborhoods.

Detailed Description
-----------------
While routine physical activity is critical to optimal health, our preliminary studies have indicated that residents of low-income communities in Los Angeles are less likely to exercise than those in high-income communities, and they are less likely to use their neighborhood parks, even when the parks are within walking distance. Parks in low-income neighborhoods tend to be smaller and serve a greater population density, but even after accounting for the size and the population served, they are still used less than parks in wealthier neighborhoods. In our preliminary studies we found that parks in low-income neighborhoods also had fewer part-time staff and offered fewer programs and organized activities than parks in higher-income areas, and these factors partly accounted for their lower use. As well, parks in low-income neighborhoods are often perceived as less safe, a characteristic associated with lower use 4. Simultaneously, the lack of use and dearth of programming may contribute to a perception of lack of safety, creating a vicious cycle. Nonetheless, we have documented that when parks in low-income neighborhoods offer events and activities, they can be just as busy as parks in higher-income areas. We hypothesize that limited park use in low-income areas can be attributed to the lack of organized and reliable infrastructure of activities that meet the needs of local residents and that offering more activities and programs in parks will increase park use and park-based physical activity. According to the Task Force on Community Level Preventive Services, community-level campaigns are both effective and scalable.6 For the past eight years, we have conducted research in public neighborhood parks and found that these venues offer great potential for increasing physical activity for populations. Based upon this work, as well as our previous work on the cost-effectiveness of physical activity interventions, we propose to test community-level campaigns targeting low-income populations that will be relatively low-cost and easy to replicate. The proposed study has three specific aims: Using a full factorial design, compare whether park use and population physical activity in low-income neighborhoods increase with the availability of a) more organized physical activity classes, including zumba, line dancing, and aerobics indoors and outdoors, and/or b) a loyalty program approach that rewards frequent park users. Determine whether either of these two approaches changes the perception of park safety and neighborhood safety. Identify the cost effectiveness of both approaches in terms of dollars spent to generate increased physical activity in parks as measured through systematic observation. Most Los Angeles parks have full-time staff, but their role has become increasingly administrative. Park staff may not have the time or the skills to lead physical activity programs and activities nor conduct effective outreach to the community to promote these activities. Although there is a small literature on best practices for parks, there is no underlying foundation of rigorous scientific research, and there has been no identification of which park practices, designs, or activities lead to the most physical activity in a community. Standard practice is currently based primarily on anecdotes, demands of special interest groups, and the experience of professionals. The science of objectively measuring physical activity in parks is new, developed only in the past decade. Because neighborhood parks are settings designed for moderate to vigorous physical activity (MVPA) and are accessible to 70% of the US population, identifying which programs help populations achieve physical activity goals at a reasonable cost would be highly useful, particularly for groups disproportionately affected with chronic diseases that could be reduced with physical activity. Parks are community resources typically funded by dedicated revenue streams and fee-based programs, yet park systems frequently lack the tools and resources to either market programs or measure their reach or effectiveness. Our study will document all the steps required for implementing and maintaining two physical activity promotion interventions--one a standard approach offering traditional organized physical activity programs, the other an innovative application of popular customer loyalty programs. We will determine their impact on physical activity and their cost-effectiveness.

Official Title
-----------------
Promoting Physical Activity In High Poverty Neighborhoods

Conditions
-----------------
Physical Activity

Intervention / Treatment
-----------------
* Behavioral: Free physical activity classes
* Behavioral: Frequent User


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Parks are in low-income neighborhoods; individuals visit parks and/or live within 1 mile radius of the park; - Exclusion Criteria: Parks are not in low income neighborhoods; individuals do not visit the park and do not live within a 1 mile radius -

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Frequent User Arm<br>Park users will be able to earn rewards or prizes by coming more frequently to the park | Behavioral: Frequent User<br>* Participants can become eligible for prizes by visiting the park more frequently<br>|
| Experimental: Free Physical Activity Classes/programs<br>We will offer at least 100 free physical activity classes at the park | Behavioral: Free physical activity classes<br>* 100 hours of free activity classes will be provided<br>|
| Experimental: Combined arm<br>We will offer free classes and the frequent user program at the park | Behavioral: Free physical activity classes<br>* 100 hours of free activity classes will be provided<br>Behavioral: Frequent User<br>* Participants can become eligible for prizes by visiting the park more frequently<br>|
| No Intervention: Control<br>Business as usual, no special physical activity programs offered | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage Change in Park-based Physical Activity | Physical activity was measured in MET-hours (Metabolic equivalents) | difference between baseline and follow-up (1 year) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Park Use (% Change) | We will count the number of parks users and compare differences between the number counted at baseline to the number counted at follow-up | baseline versus 1 year | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Physical activity, parks, programming, public health