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Published in final edited form as: Prev Med. 2021 Mar 18;147:106528. doi: 10.1016/j.ypmed.2021.106528

Effects of Park-Based Interventions on Health-Related Outcomes: A Systematic Review

Kathryn P Derose a, Deshira D Wallace b, Bing Han c, Deborah A Cohen d
PMCID: PMC8096710  NIHMSID: NIHMS1684964  PMID: 33745954

Abstract

Increasing use of parks for physical activity has been proposed for improving population health, including mental health. Interventions that aim to increase park use and park-based physical activity include place-based interventions (e.g., park renovations) and person-based interventions (e.g., park-based walking or exercise classes). Using adapted methods from the Community Guide, a systematic review (search period through September 2019) was conducted to evaluate the effectiveness of park-based interventions among adults. The primary outcomes of interest were health-related, including physical and mental health and moderate-to-vigorous physical activity. Twenty-seven studies that met review criteria were analyzed in 2019 and 2020. Seven person-based studies included generally small samples of specific populations and interventions involved mostly exercise programming in parks; all but one had an average quality rating as “high” and all had at least one statistically significant outcome. Of the 20 place-based interventions, 7 involved only 1 or 2 parks; however, 7 involved from 9 to 78 parks. Types of interventions were predominantly park renovations; only 5 involved park-based exercise programming. Most of the renovations were associated with increased park-level use and physical activity, however among those implementing programming, park-level effects were more modest. Less than half of the place-based intervention studies had an average quality rating of “high.” The study of parks as sites for physical activity interventions is nascent. Hybrid methods that combine placed-based evaluations and cohort studies could inform how to best optimize policy, programming, design and management to promote health and well-being.

INTRODUCTION

Regular physical activity (PA) contributes to many positive health outcomes, including longevity, improved quality of life, and reduced incidence of cardiovascular diseases, diabetes, depression, certain cancers, and obesity (U.S. Department of Health and Human Services, 1996). Conversely, physical inactivity is estimated to contribute to the burden of disease of various conditions (e.g., 6.7% of coronary heart disease, 8.3% of type 2 diabetes, 12.4% of breast cancer, and 12% of colon cancer) and cause 10.8% of premature mortality (Lee et al., 2012). Accelerometer-based estimates suggest that fewer than 10% of adults in the U.S. meet the minimum level of recommended PA, and the time in moderate-to-vigorous PA (MVPA) declines with age and is lower among women than men (Tucker et al., 2011).

There is increasing enthusiasm about the role of parks in promoting PA, along with a significant movement to create more parks and enhance their infrastructures, facilities, amenities, and aesthetics (Godbey et al., 2005; Kaczynski and Henderson, 2008; Kruger et al., 2007). An estimated 70% of persons in the U.S. live within walking distance of a park (Godbey et al., 1992); further, parks have been found to facilitate PA in minority communities (Godbey et al., 2005; Reed et al., 2012; Tinsley et al., 2002). In 2016, voters across the nation approved local and state ballot measures that provided more than $6 billion for parks and land conservation (The Trust for Public Land, 2016). Parks are thus an accessible setting for implementing PA interventions. Further, research has found that adults engage in longer bouts of MVPA when they are outdoors compared to indoor settings (Dunton et al., 2009). In addition, research indicates that the natural environment and contact with nature can improve health and mental health through not only increased PA, but also through improved air quality, social contacts, and reduced stress (Hartig et al., 2014).

Studies have found that parks are underutilized, particularly for PA (Cohen et al., 2010; Cohen et al., 2007; Floyd et al., 2011; Hunter et al., 2015; Sasidharan et al., 2005). This underutilization is particularly acute in high poverty areas, partly due to a dearth of supervised activities and community outreach, especially targeting adults (Cohen et al., 2012a; Cohen et al., 2016), as well as systemic issues such as racism, safety, and poorly maintained park facilities (Stodolska et al., 2011) and lack of greenspace (Casey et al., 2017).

Interventions are needed that address community concerns, target the built environment, and “activate” park use. Competition for leisure time from entertainment media can be a significant barrier to PA (Sturm and Cohen, 2019). However, studies that stress outreach to the community suggest that parks can successfully compete for people’s leisure time. For example, a large park-based randomized controlled trial (RCT) found that parks that were activated by factors like signs, banners, events, activities, and improved community outreach and service orientation saw greater increases in park-level use and park-based PA (Cohen et al., 2013). Parks can be important venues for family gatherings and socialization, particularly among Latinos and other ethnic groups (Derose et al., 2015; Gobster and Delgado, 1993; Sasidharan et al., 2005). Finding ways to leverage such events and expand park use and park-based PA offers potential for increasing community PA and improving population health.

To inform such strategies, a systematic review of published peer-reviewed articles that reported on park-based interventions was conducted. Previously published systematic reviews involving parks have focused on observational studies only (Evenson et al., 2016; Joseph and Maddock, 2016), the existing physical environment in and near parks (Zhang et al., 2019), or on park-based interventions with a specific subpopulation – e.g., individuals with disabilities (Saitta et al., 2019). Hunter et al. (2015) conducted a systematic review of urban greenspace and PA interventions and identified 12 studies, of which 8 were conducted in parks. The present systematic review complements these prior reviews by extending the search for intervention studies involving parks and assessing their effects on health-related outcomes, including PA and mental health. Interventions focused on adults (18+ years) and children were initially the focus of the search; however, since studies focusing only on children were found to differ qualitatively, their results are addressed in a separate article.

METHODS

This systematic review followed the reporting guidelines and criteria set in the Preferred Reporting Items for Systematic Review (PRISMA) statement and standard in systematic review protocol reporting (PRISMA-P) (Moher et al., 2009). The protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO), CRD42018109165 and described in-depth elsewhere (Wallace et al., 2020). Briefly, a search was conducted for articles that reported health-related effects of an intervention in one or more parks that was focused on adults or the general population. Parks were defined, open spaces accessible to the general public, in urban, rural, or suburban areas that are managed by government or non-governmental entities. Article inclusion criteria were: (1) peer-reviewed, (2) published in English, Spanish, or Chinese, (3) evaluated physical and/or mental health-related outcomes, (4) described an intervention conducted in a park accessible to the larger community, and 5) used quantitative study designs and research methods. Study designs included RCTs, cluster RCTs, and quasi-experimental designs with or without comparison groups.

Systematic searches of Pubmed/MEDLINE, Scopus, Cochrane Library, and Web of Science databases were conducted through September 2019 using keywords associated with parks, health-related outcomes, and study design (see Appendix). Two screeners trained on the inclusion criteria and experienced in systematic reviews screened relevant studies in the Covidence system, which tracks excluded and included studies and any discrepancies that require additional review. Next, these two screeners independently reviewed the full text of included articles, recording the rationale for excluding studies. Any discrepancies during the full-text screening were reviewed by a senior author for reconciliation.

Data were extracted using an adapted version of the Guide to Community Preventive Services abstraction form (Zaza et al., 2000), including descriptive information about: (1) study design and intervention; (2) study population; (3) results; and (4) study quality. Data were managed through Qualtrics, an online survey platform, and included both structured and open-response options. Once trained on how to use the abstraction form, two co-authors independently extracted study information; quality assurance was conducted to ensure accurate extraction.

Regarding study quality, the Guide to Community Preventive Services (Zaza et al., 2000) was created to be flexible to allow the evaluation of studies with different designs (randomized controlled trials and quasi-experimental) and intervention types. The key domains assessed to determine study quality are: 1) descriptions of the intervention and study population, 2) sampling (e.g., selection bias), 3) measurement (exposure of intervention, validity and reliability of outcomes and other variables), 4) analysis (e.g., appropriate statistical testing, controlling for design effects), and 5) interpretation of results (retention, procedures to limit bias). Within each domain are 2–6 questions to elicit information regarding issues that could affect interpretation the study results. Studies were classified as having “high,” “medium,” or “low” study quality based on the most prevalent rating for each of the subcategories. Study design was not included in the quality assessment, though it was noted elsewhere in the abstraction. Quality for all included studies were assessed and reviewed by the first and second authors.

Evidence was synthesized to provide a descriptive summary of the study characteristics and evaluate and summarize the quality of the included studies. A table with intervention and primary outcomes summarizes findings as presented in each article with statistical significance noted. Given the heterogeneity of included studies, meta-analysis was not possible. Instead, the coefficient of each reported health-related outcome was described at the study level.

RESULTS

Figure 1 provides an overview of the process and selection of the final 27 articles included in the review. After removing duplicates (2145), 6227 records were screened of which most were excluded for not being relevant (5617, of which 58 were in a language other than English, Spanish, or Chinese but were also not relevant), qualitative data only (50), or no health-related outcomes (502). A total of 58 full-text articles were assessed for eligibility and 31 were excluded because the intervention was not set in a park or the intervention focused only on youth populations.

Figure 1:

Figure 1:

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Flow chart for the search and study selection process using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)

Appendix Table 1 (on-line), provides key details of each of the 27 studies included in the review. This includes information on study locations and participant sociodemographic characteristics. Of the 27 studies, 13 took place in the United States (10 California, 1 Florida, 1 Illinois, and 1 Michigan), 4 in Australia, 2 in the United Kingdom (1 England, 1 Scotland), 2 in Colombia, and 1 each in Canada, Finland, Lithuania, Spain, Brazil, and Uruguay. Regardless of location, most focused on urban areas, however, few reported details about the socio-demographic characteristics of study participants and the neighborhoods in which the parks were located. Only 8 interventions reported focusing on low-income or racial-ethnic minority populations.

Appendix Table 2 (on-line), provides an overview of the methodological details and outcomes. This includes information on interventions; study design; and primary outcomes and results. Given the focus on evaluating the nature of interventions in parks and their effects on PA and health-related outcomes, studies were organized by the level of the intervention. Seven were person-based interventions, where individuals or dyads were assigned to different groups, and 20 were place-based interventions, where parks were assigned to receive an intervention such as renovations or PA programming.

Among the 7 person-based interventions, all were relatively small pilot studies, with total sample sizes ranging from 20 – 153 adults spread across 2–3 arms. The interventions were relatively brief – ranging from a onetime walk in a park and city street (Sellers et al., 2012) to 18 weeks of twice weekly supervised exercise sessions in a park (Sales et al., 2017). All 7 person-based interventions had at least one statistically significant outcome. Among the studies with general populations, park walks of various durations and frequencies (daily for 15 minutes across 5 weeks, 45 minutes weekly for 6 weeks) were associated with improved self-esteem, overall mood, and recovery/well-being (Barton et al., 2012; de Bloom et al., 2017). Two studies focused on seniors with balance or fall concerns and found that weekly and twice weekly park-based exercise sessions were associated with improved clinical outcomes (functional balance, physical fitness, hand grip strength, single leg stance, and knee strength), along with improved quality of life (Leiros-Rodriguez and Garcia-Soidan, 2014; Sales et al., 2017). A brief intervention consisting of daily 30-minute walks in a city park vs. an urban street with adults that had coronary artery disease found that after only 7 days, city park walkers experienced reductions in diastolic blood pressure (Grazuleviciene et al., 2016). A onetime park walk vs. walking in the city found that park walking had improved cadence and 10 minutes bouts of moderate-to-vigorous activity (Sellers et al., 2012). Finally, the only intervention among the person-based that reported focusing explicitly on a low-income population, found that a family intervention composed of 3 successive Saturday nature outings at local parks, which included a brisk 60 minute walk, was associated with reductions in perceived stress (Razani et al., 2018).

Among the 20 place-based interventions, there was a wide range from small studies to large trials. Of those involving only 1 or 2 parks (Cranney et al., 2016; del Campo Vega et al., 2017; Salvo et al., 2017; Tester and Baker, 2009; Veitch et al., 2012; Veitch et al., 2018), all used nonrandom designs and involved environmental changes to a park (e.g., installation of outdoor gym, street enclosure to enable green space and skate park, or other renovations) and found statistically significant increases at the park-level in park use and park-based MVPA as measured by the System for Observing Play and Recreation in Communities (SOPARC) (McKenzie et al., 2006). Similarly, among the 6 studies involving 3–6 parks, all were non-randomized or natural experiments where some parks underwent environmental changes (e.g., creation of pocket parks, park renovations, creation of off leash areas, installation of smoke-free signage) or exercise programming and were compared with similar parks that did not. Of these, 3 resulted in park-level increases in park use and park-based PA (Cohen et al., 2019; Cohen et al., 2014; Panken and Holaly-Zembo, 2015). or reduction of cigarette butts found in parks (Platter and Pokorny, 2018). The one study that examined park-based exercise programming found that it was associated with increased park use and park-based PA during class time compared to other parks in the area, though the spillover to non-class time was smaller (Han et al., 2015). The remaining study created an off-leash areas for dogs and had mixed results and some indication that such modifications lowered PA intensity among children (McCormack et al., 2016).

The 10 place-based interventions that included larger numbers of parks (9–78) included a mix of intervention strategies, including PA programming in parks and park renovations. Three of these interventions were conducted in Latin America (2 in Bogotá, Colombia, and one in Recife, Brazil) and assessed the effects of providing cost-free, supervised PA classes in parks. All three were natural experiments (comparing parks where the program was implemented to comparison parks) but used slightly different evaluation methods. The Bogotá studies used a 3-arm study – parks with existing Recrovía programs (3), parks implementing future Recrovía programs (3), and control parks (3). The first Bogotá study used only baseline measurements and found that park-level MVPA among adults measured by SOPARC in parks with the free classes was greater than those parks without the classes, especially among women, however, the observations were done only on Sundays, around the time that classes were offered (Sarmiento et al., 2017). The second study followed individual participants in the newly established Recrovía programs, thus had a pre- and post-, but did not find any significant changes in PA after 6 months of implementation (Torres et al., 2017). The Recife study also compared parks where there was an on-going program (Academia de Cidade or ACP, 5 parks) to parks without the program (5) and, using standard SOPARC methods that include observations throughout the day and week, found that ACP parks had higher levels of park usage and vigorous PA and lower levels of sedentary time (Parra et al., 2010).

Of the remaining place-based strategies among larger numbers of parks (12–78), four were in Los Angeles one was in Chicago. The largest (Chicago) involved playground renovations + community engagement in 33 neighborhoods and 39 matched control parks (not yet renovated) and used SOPARC for pre- and post-measurements and found statistically significant increases in park utilization and MVPA and reductions in sedentary activity (Slater et al., 2016). Of note, the renovations resulted from applications from community groups, and these groups were included in the selection process of new equipment, involved in installation, and asked to propose plans for ongoing maintenance.

The studies in Los Angeles also involved community engagement in varying degrees, although some focused on park renovations while others focused on PA programming. Two of these studies involved RCT designs. The first involved 50 parks in Los Angeles across various income levels and was notable given the 3-arm cluster-RCT design. This study found that parks where park advisory boards and park directors were involved in examining park use, marketing training, and design and implementation of strategies to increase park use and PA had significant increases in park-level PA intensity as well as increases in individual-level self-reported exercise and park use by neighborhood residents (Cohen et al., 2013). The other RCT compared 3 intervention strategies – free PA classes, a frequent user program with prizes, and a combination of these two programs – vs. a control arm among parks in high poverty neighborhoods; it did not find statistically significant increases in overall park-level use and park-based PA nor among neighborhood residents’ self-reported park use and exercise (Cohen et al., 2017). Two earlier studies in Los Angeles involving park renovations also had contradictory results. The first did not find increased park use and PA in 5 parks that underwent large (>$1 million) capital improvements (e.g., new gymnasiums) as compared to 5 matched controls, however city budget cuts after the improvements led to reductions in hours of operations and fewer organized programs and events (Cohen et al., 2009). On the other hand, another study in Los Angeles involving 12 parks in low-and middle-income parks neighborhoods of Los Angeles where exercise equipment (Fitness Zones) were installed in some of the parks did find statistically significant park-level and individual level increases in park use (and individual self-reported exercise) (Cohen et al., 2012b).

Among the 7 place-based studies that reported focusing on low-income and/or racial ethnic minority populations, all had statistically significant improvements in park-level outcomes and/or person-level outcomes. Park-level outcomes that improved included observed park use [e.g., new park users (Cohen et al., 2012b), number of users (Cohen et al., 2014; Han et al., 2015; Veitch et al., 2012; Veitch et al., 2018), observed PA intensity (Cohen et al., 2013; Han et al., 2015; Veitch et al., 2012; Veitch et al., 2018), and walking in the park (Veitch et al., 2012). Individual-level outcomes that improved included new park users (Cohen et al., 2009; Cohen et al., 2012b), perceptions of park safety (Cohen et al., 2009), and frequency of park use and exercising (Cohen et al., 2013).

Overall study quality was determined as a combination of the level of description of the study, the sampling, measurements used, data analysis, and interpretation of results. All but one person-level intervention study was deemed high quality. In contrast, only 8 of the 20 place-based intervention studies scored as high quality. The reasons pulling studies from high quality was often related to poor descriptions of the sampling processes and not using a probability sample thereby negating generalizability, lack of description regarding the reliability or validity of the study measures, or poor description of the analysis plan, such as poor justification for the statistical approach or not specifying control of design effects, and high attrition.

DISCUSSION

Although the literature on the potential for parks to improve PA and health is growing, the science of how to harness this potential is in its infancy. In this systematic review that did not restrict the searches in terms of publication dates, we still only found articles that had been published between 2010 and 2019 or the last decade, with half of them published between 2017–2019. Earlier reviews involving parks had involved mostly observational studies to assess the influence of park and neighborhood attributes on PA and called for “innovative strategies to promote MVPA among park users” (Joseph and Maddock, 2016) and the need for prospective and intervention studies to better understand how parks can promote PA (Zhang et al., 2019). The one review that had focused on interventions in urban greenspaces called for more interventions that combine PA programming with park/greenspace environmental changes (Hunter et al., 2015). The present review finds that more recent literature has addressed these calls to some degree, as discussed below.

Interestingly, place-based interventions were more common than person-based interventions. The few reviewed person-based interventions could be considered modest, with small samples and limited intervention programming. On the other hand, the reviewed place-based studies were also limited in that a third involved only 1 or 2 parks, likely reflecting the challenges of including large numbers of parks for both logistical and resource reasons. Even with these limitations, it did appear that park renovations had robust effects on park use and park-based PA. Studies that implemented park-based PA programming found robust effects on park use and park-based PA during class time, but these effects did not appear to spill over into non-class time, which is likely needed to have a large impact on community-level PA. Community engagement appeared to play a role in some of these studies.

In considering needed areas of research for the relatively new park intervention literature, it is important to recognize the strength and limitations of the different types of evaluations that have been undertaken. The studies measuring individual-level outcomes generally try to follow a cohort of people and compare their skills, functioning or behaviors prior to the intervention with behaviors/skills achieved as a result of the intervention. Depending on how many parks are involved and the number of study participants from each, cohort studies can be labor-intensive and require considerable effort to track and retain participants. Therefore, they may suffer from having small samples of individuals, high drop-out rates, or being unrepresentative. Given the extensive commitment required for participation, study volunteers may be very different from those who do not participate. With intensive interventions, replication may be difficult, especially if the measurement of participants contributes to the outcome, by reinforcing measures or increasing the intensity of the intervention. Some implementation studies have failed to achieve the same efficacy rates as the initial intervention [e.g., the Diabetes Prevention Program (Kaholokula et al., 2014; Ma et al., 2013)]. However, cohort studies that have large samples of individuals that are representative and tracked over time may provide among the highest quality evidence of an intervention’s effectiveness. Further, person-based interventions can engage completely new park users who otherwise would not have considered going outdoors for health-enhancing activities.

In contrast, most place-based studies rely on serial cross-sectional data and/or snapshots of activity occurring at the park-level. This can include systematic observations and surveys of park users and community residents, as was done in 5 of the 19 place-based studies in our review. While sample sizes can be very large, the studies cannot rigorously demonstrate the impact of the intervention on specific individuals. The persons observed or participating are likely to be different at each measurement point and the results only show what happens in a place, rather than to an individual. The changes in the place-based data may suggest an individual impact but given the lack of repeated measures on the same persons, the proof is still largely lacking.

Yet the strengths of place-based evaluation approaches are that they allow assessments of interactions between people and settings—elements that play a large role in guiding human behaviors. They are sometimes easier to implement, given the lack of need for following specific individuals over time. Place-based findings may suggest appropriate or inappropriate designs, policies or management practices. They are often helpful in determining whether the intervention is having a broader impact on the community. Additional rigorous individual testing can confirm to what extent these impacts are affecting individuals in the communities. For example, to demonstrate why a place-based study may not be generalizable to individuals, it’s worthwhile to examine some of the details of the study examining smoking in parks, a behavior closely tied to health outcomes. The study provided evidence that non-smoking policies resulted in fewer cigarette butts in the park indicates less smoking in the park (Platter and Pokorny, 2018), but it does not prove that it helped any person smoke less. Smokers may have decided to smoke the exact same number of cigarettes in other settings. Yet, if there were no difference in the number of cigarettes found, we could conclude that it is unlikely that the no-smoking policy had any effect at all. Additional population-based studies may be needed to confirm individual-level impacts. However, another advantage of place-based interventions is that they have the potential to have a larger impact on the community than person-based interventions, which only reach certain individuals.

This review found that all but one of the person-based interventions were deemed high quality overall, while only 9 of 20 place-based interventions were deemed high quality. This is in part because person-based study designs follow a well-described 100 plus-year tradition of scientific methods. In contrast, many of the evaluation strategies employed in place-based methods have only been developed in the past 20 years. Certainly, standardization efforts are needed for place-based outcome measures (park-level and individual-level) to be able to conduct meta-analysis. The consistent use of SOPARC among 16 of the 20 place-based interventions is a good start. The place-based studies rated as high quality may provide useful references to researchers planning for future intervention studies. However, rethinking what defines quality in place-based studies is needed, given the complexities both in execution of built environment interventions as well as measurement of impact (e.g., among individuals, neighborhoods, communities). As noted by others, the primary focus on study design in evidence assessments of clinical interventions is inadequate for public health intervention evaluation (Rychetnik et al., 2002). Community interventions are complex social processes and randomized controlled trials have several drawbacks such as not being able to investigate diversity across settings (Trickett et al., 2011). New paradigms are needed for understanding changes in community health from such interventions as opposed to the health of individuals.

Limitations

This review had several limitations. Given the heterogeneity of studies and varied reporting, it was not possible to conduct a meta-analysis and calculate the effect of various intervention types on different health outcomes. Also, since the search was limited to articles in English, Spanish, or Chinese it is possible that park intervention studies published in other languages were missed. However, as a check, we did review the title and/or abstracts of 58 articles that were excluded due to being published in other languages and found that all of them did not meet other criteria.

The review did include studies from 10 different countries across 4 continents (North America, South America, Europe, Australia). Nevertheless, most studies were in the U.S. and almost all were conducted in urban areas. Further, less than a third of the studies had an explicit focus on low-income and racial-ethnic minority populations, thus the potential of parks to address health inequities has not been truly tested. Additional interventions are needed in geographically diverse areas and populations to improve our understanding of whether and how park interventions can improve health across various contexts and populations. As with all reviews, it is possible that studies were missed, but a reference librarian specifically trained in systematic searches determined the best set of databases and search criteria. Although adults or general populations were the focus of this review, mean ages were not reported in over half (n=15) of the studies. The primary reason was that the assessments used park-level observations only (using SOPARC, which identifies broad age groups) rather than collecting data from individuals. And although “greenspace” was one of the search terms, open spaces such as woodlands, nature areas, wooded walking trails, and vacant lots were excluded. Finally, given the tendency toward publication bias (Dickersin, 1990, 1997; Easterbrook et al., 1991), the evidence that park interventions have on health-related outcomes may have been overestimated.

Conclusion

This review demonstrates that the study of parks as intervention sites is nascent and additional intervention studies are required to fully understand the impact of park-based programming and park-level changes in management and design. Hybrid methods that combine placed-based evaluations and individual-level cohort studies should be developed. Further, adapted or new methods for assessing study quality and evidence produced by these hybrid designs are needed. These complementary approaches may prove to be the ultimate comprehensive and rigorous means to answer pressing questions about how to best optimize policy, programming, design and management to promote health and well-being.

Supplementary Material

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Table 1:

Study Quality Assessment

First author, year Descriptions Sampling Measurement Data Analysis Interpretation of Results Average Quality
Person-Based Interventions
Barton, 2012 High Medium High High Low High
de Bloom, 2017 High High Medium High Low High
Grazuleviviene, 2016 High High High High High High
Leiros-Rodriguez, 2014 High High High High Medium High
Razani, 2018 High High Low High High High
Sales, 2017 High Medium High High Medium High
Sellers, 2012 Medium Low Low High Low Low
Place-Based Interventions
Cohen, 2009 High High High Medium High High
Cohen, 2012 High Low High High Low High
Cohen, 2013 High Medium Low High High High
Cohen, 2014 High High High High Medium High
Cohen, 2017 High High High High Medium High
Cohen, 2019 High High High High High High
Cranney, 2016 High Medium Medium High Low Medium
de Campo Vega, 2017 Medium Medium Medium High Low Medium
Han, 2015 High High High Medium Medium High
McCormack, 2016 Low Low Low High Low Low
Panken, 2015 Low Low Low Low Low Low
Parra, 2010 Medium Medium Low High Low Medium
Platter, 2018 High High High High High High
Salvo, 2017 Medium Medium Medium Low Low Low
Sarmiento, 2007 High Low Medium High Low Medium
Slater, 2016 Medium High Low High Low Medium
Tester and Baker, 2009 High Medium Medium Medium Medium Medium
Torres, 2017 High Low Medium Medium High Medium
Veitch, 2012 Low Low Medium Medium Low Low
Veitch, 2018 High Low Medium High Medium Medium
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HIGHLIGHTS.

  • Of 27 park-based interventions, 20 were place-based and 7 were person-based

  • Place-based interventions involved mostly renovations, few had exercise programming

  • Hybrid designs are needed to evaluate park-based interventions on community health

ACKNOWLEDGMENTS

The authors thank Jody Larkin, MS., Supervisor Research Librarian at RAND, for her assistance with the systematic searches.

Funding statement:

This study was supported by the National Institutes of Health (NIH) under Award Number R01CA218188. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Footnotes

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Conflicts of Interest. None.

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