Chapter 10

If we want more evidence-based practice, we need more practice-based evidence.*

Chapter 10
Community Recreation and Fitness

Table of Contents


HEADLINES, TIMELINES, & MILESTONES  (updated to Sept. 30, 2003).
REFERENCES - since publication of 8th edition



Community recreation and fitness programs represent a bridge between mental health and physical health programs, between age groups, and between health and other sectors. The contributions of the recreational, commercial and educational sectors to community and population health can be seen most clearly in community recreation and fitness programs, products, and facilities. The placement of this chapter and its contents are intended to emphasize these relationships. Additional objectives are to identify relationships between physical, mental and social health promotion programs as exemplified in some of the community recreation and fitness programs described in this chapter; and to identify opportunities for private sector and multidisciplinary contributions to health promotion through community recreation and fitness.


The mental, physical, social, and economic benefits of recreation and physical fitness activities are described for individuals, families, groups and communities. Agencies and programs providing leadership and support for the development of recreational and fitness facilities and resources are described and ways of developing community resources for recreation and fitness are suggested. Worksite, school and youth programs are described. Objectives for 2000 are suggested based on national objectives in physical fitness and exercise. 


Frist introduces Senate bill on obesity reduction. June 29, 2005. Track the bill on Library of Congress website at

Weather, especially humidity, limits exercise. Am J Health Behav, July/Aug 2005.

Step Up to Health ... It Starts In Parks (Jan 2005).
Since 1999, the National Recreation and Park Association (NRPA) has been working with a number of national partners to develop new approaches to improving the health of all Americans through parks and recreation. Over 100 local park and recreation agencies of all types and sizes have assisted NRPA in designing new strategies in both health and sport. Designated as Magnet Centers, these agencies have innovated and evaluated a national community mobilization model that has lead to the "Step Up to Health - It Starts In Parks" national grassroots initiative that is being launched this year. 

Malaria in resort areas of Dominican Republic. (MMWR, January 7, 2005).

South Carolina : Quirk in state’s tattoo law comes to light. “Tattoo law comes with sticking point”

Charlotte Observer Jan 1, 2005.  Henry Eichel


Federal government may consider X-rays for outgoing passengers. “Air passenger X-rays: Health questions arise”. (The Baltimore Sun, Dec 31, 2004 )     Judy Foreman

Cause and Effect Linked Again: Fat and Disease(New York Times, Sept. 30, 2003). Sedentary living and diet have produced an obesity epidemic that has been linked to increased rates of Type II diabetes. Recent research has now linked it also to Type I diabetes. For a literature review of community-based programs to prevent Type II diabetes through increased physical activity.

Strength Training Helps Elderly Rebuild Muscles, Maintain Health. September 30, 2003.

Drink Specials Go Hand in Hand with Dangerous Collegiate Behaviors. September 17, 2003.

Alcohol's Benefits for Brain Power May be Overestimated. August 28, 2003.

Counseling Helps Older Adults Add Exercise to their Lives. August 12, 2003.

Mirrors Can Make Women Feel Worse About Working Out. August 1, 2003.

Beach Goers Add Sun Protection, But Persist in Sun Exposure. Aug 1, 2003. Health Psychology.

E. Coli Tragedy in '98 Changed Water Park Safety. (Atlanta Journal-Constitution, June 14, 2003). An E. coli outbreak in 1998 has left some of the 26 children stricken at a kiddie pool in a water park disabled. Sweeping changes in state regulations and water park practices in monitoring and treating their water have virtually eliminated such outbreaks in Georgia. Some water parks have abandoned standing water kiddie pools in favor of fountains and dancing water jets or sprays.

Hospitals Join the Fitness Business; Health Club Owners Grumble About Unfair Competition. (New York Times, June 7, 2003). Hospitals across the country, seeking new sources of revenue, are getting into the fitness business with gyms, health club facilities, and exercise programs, under the banner of disease prevention and health promotion. Some cities have restrained this encroachment on the previously established health clubs' business, who complain that the hospitals' tax-exemption advantages give them an unfair commercial advantage. The restraints have forced some hospitals to limit their clientele to people undergoing physical rehabilitation.

Worksite Counseling May Increase Physical Activity, Fitness. American Journal of Preventive Medicine, Apr. 2003.

Lower-Income Neighborhoods Lack Exercise Resources.  (Atlanta Journal-Constitution, April 14, 2003). Studies that have addressed the ways in which urban design and suburban sprawl have affected physical activity and inactivity began to get considerable public attention in the Spring of 2003. A special issue of the American Journal of Public Health, and one of the American Journal of Health Promotion, both appearing in September 2003, featured these types of studies. See also Health Behavior News Service, Aug. 28, 2003.

    Wanted: Easy Access to Walking Areas for Inactive Americans. Aug. 28, 2003.

CDC Health News: Tropical Trips Bring Dengue to America. (Atlanta-Journal Constitution, April 5, 2003). Travelers to exotic places in Asia, the Caribbean, Central and South America, and Africa are bringing home a mosquito-borne viral infections for which there are no vaccines, including malaria and dengue.

New Worry for Hot Tub Users. 

Side Effects: Jog Your Memory? At the Gym? 

Gyms Fall Short of Full Accessibility for People With Disabilities  Jan. 10, 2003

Group Effort Helps Motivate Young Mothers to Exercise.  July 23, 2002

At-Home Exercise Helps Caregivers Care for Themselves.  May 23, 2002

Games' 'Rumble' Linked to Hand Pain. (New York Times, Feb 12, 2002). PlayStation, a video game with a "rumble board," produced by Sony, was found in a case study published in the British Medical Journal to produce a condition in the hand of a boy, age 15, that has symptoms similar to those in workers who use pneumatic drill tools and chain saws.

When Putin Says 'Exercise!' Russia Jumps to It. (New York Times, Feb10, 2002). President Vladimir V. Putin gave a pep talk to Olympic athletes, noting that a slothful population was sapping Russia of its health and its potential to rebuild itself as a great power. The news of this pronouncement stimulated a flurry of enrollment in calisthenics, but also a debate about the wisdom of attempting to change the behavior of individuals from the central government, which evokes memories of "The habit to obey, to feel the state hovering over."

Koop: Americans Need to Get Active. WASHINGTON (AP, June 9, 1999) The doctor who declared war on smoking is setting his sights on the couch potato. Dr. C. Everett Koop, former U.S. surgeon general, called Wednesday for fitness to be a national health priority, saying that Americans' inactivity has reached "crisis proportions." He's offering an Internet guide to Americans wanting to craft their own fitness plans.  The Web site for Koop's Shape Up America is .

Rx For Physical Activity: Seniors in Action. MISSISSAUGA  (CNW, May 12, 1999) Canada's family doctors are writing a new kind of prescription for their patients in the months to come. The Rx sets a daily regimen for physical activity. Representing more than 14,000 family doctors across the country, the College of Family Physicians of Canada (CFPC) will be announcing a new program for family doctors in Victoria this week to help them convince patients that a sedentary lifestyle puts them at risk.

To Succeed in Business, Get to the Gym (International Herald Tribune March 27, 1998).The image of corporate executives in the past was of pot-bellied men with cigars. Today's executive projects an image of fitness and stamina.

Public Faces Tough Choices As Parks Decline, Costs Rise. (USA Today August 29, 1997) It is estimated that US National Park Services requires about $8 billion US to do everything it is mandated to do. Some 266 million people visit US Parks yet funds and access decline.


For related news stories, please click here. 


Am. Assoc. for Leisure and Recreation, & National Assoc. for Sports & Physical Education
American Alliance for AHPERD
1900 Association Drive
Reston, VA 22091
Phone: (703) 476-3481


National associations dedicated to recreation and sports, physical education and fitness. Publications include: Update, the alliance newspaper, and Research Quarterly for Exercise and Sport. Maintains a Directory of Computer Software with Application to Sport Science, Health, and Dance.

Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition and Physical Activity.

State legislative bills on nutrition and physical activity

Atlanta, GA

Searchable Database Tracks State Bills on Nutrition, Physical Activity. A new CDC database now makes it easier to keep up with state legislation related to nutrition and physical activity. The State Legislation
Searchable Database allows anyone to search for state bills from 2001 to the present related to nutrition and physical activity. The name of the
primary sponsor of each bill is also included in the record. Users can
use search fields, enter keywords, or search the entire database.


President's Council on Physical Fitness and Sports
Department of Health and Human Services
450 5th Street, NW, Suite 7103
Washington, DC 20001
Phone: (202) 272-3430

The Council produces informational materials on exercise, school physical education programs, and physical fitness for youth and adults. A bimonthly newsletter features articles on exemplary physical fitness programs and notices of free materials.

Canadian Fitness and Lifestyle Research Institute
201-185 Somerset Street West
Ottawa, Ontario, CANADA K2P 0J2
Phone: (613) 233-5528
Fax: (613) 233-5536

The Institute takes an integrated approach to understanding active living and strives to address fitness issues from the complementary perspectives of the health professions, the sociological and psychological sciences, and the physiological and Biological sciences.

Health Promotion Resource Center
Stanford Center for Research in Disease Prevention
1000 Welch Road
Palo Alto, CA 94304-1885
Phone: (415) 723-1000

Catalog of Materials for Health Promotion includes program books on worksite and community program planning and implementation.


American Therapeutic Recreation Association
P.O. Box 15215
Hattiesburg, MS 39404-5215
Phone: (601) 264-3413
Fax: (601) 264-3337

Brochures and other public and professional education material on the Society, the profession, and on all aspects of recreation in the U.S.

Active Living Canada
1600 James Naismith Dr.,
Glouchester, ONT K1B 5N4
Phone: (613) 748-5743

This organization provides pertinent information regarding the fitness level of Canadians. The web page has several links to research reports and surveys that are current and presented in an easy to read fashion.

ODPHP National Health Information Center
PO Box 1133, Washington, DC 20013-1133
Phone: (800) 336-4797

ONHIC offers special issues of Healthfinder, one entitled "Health Promotion Software" which contains sections on physical fitness and exercise and weight control, and one on fitness resources.

Washington Business Group on Health
Prevention Leadership Forum
229-1/2 Pennsylvania Avenue SE
Washington, DC 20003

Studies and reports on health-related issues of interest to employers and the business community, including worksite fitness programs.

Wellness Councils of America
Community Health Plaza
7101 Newport Avenue, Suite 311
Omaha, NE 68152
Phone: (402) 572-3590
Fax: (402) 572-3594

LLCOA provides direction and support services to community-based health promotion councils and publishes a free quarterly newsletter, Worksite Wellness Works. Also distributes workbooks, videos, manuals, to businesses interested in starting or expanding worksite health promotion programs.

"Just the facts" on Physical Activity and Health
Prepared by Ontario Physical and Health
Education Association (OPHEA)  

Highlights research results showing the importance of a physically active lifestyle and the associated health risks of inactivity and obesity.

1997 Alberta Survey on Physical Activity: Stages of Physical Behaviour
Prepared by

Prepared by the Alberta Centre for Active Living (ACAL)
Results and methodology of survey to determine physical activity status of
Albertans, with a list of references.

Barriers to Physical Activity: Are There Enough Hours in a day?
Prepared by the Alberta Centre for Active Living (ACAL)

Outlines results of the 1997 Alberta Survey on Physical Activity. Focuses on
perceived barriers to physical activity and includes short bibliography.

Results and methodology of survey to determine physical activity status of Albertans, with a list of references.

Hop, Skip, and Jump: What Makes Your Body Move?


A five day teaching unit from the Core Knowledge web site in which primary students examine the muscular, skeletal and nervous systems. Lessons employ centers, higher order thinking skills, and cooperative learning activities.

Barriers to Physical Activity: Are There Enough
Hours in a day?
Prepared by Alberta Centre for Well-Being (ACFWB)  

Outlines results of the 1997 Alberta Survey on Physical Activity. Focuses on perceived barriers to physical activity and includes short bibliography.

Safe Summer Fun Canadian site (14 June 1998)
The site is located at

American Academy of Kinesiology and Physical Education (1/99)

Exercise: A Guide from the  National Institute on Aging. A 100-page book. 1-800-222-2225 or

Health Canada Online has launched an informative website loaded with health and safety tips to help families make the most of the summer season. 

The American Alliance for Health, Physical Education, Recreation and  Dance:


Directory of Fitness Centers in the USA By State.


Monthly Newsletter on Fitness-Related Topics.


Active Living in Canada


American Journal on Sports Medicine



Journal References

Bernstein, M. S., Morabia, A., & Sloutskis, D. (1999). Definition And Prevalence Of Sedentarism In An Urban Population. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (6): 862-867.
    The Journal’s Home Page is at:
    ABSTRACT: Objectives. The present study sought to formulate a precise definition of sedentarism and to identify activities performed by active people that could serve as effective preventive goals. Results. The rates of sedentarism were 79.5% in men and 87.2% in women. Among Sedentary and active men, average daily energy expenditures were 2600 kcal (95% confidence interval [CI] = 2552, 2648) and 3226 kcal (95% CI = 3110, 3346), respectively; the corresponding averages for women were 2092 kcal (95% CI = 2064, 2120) and 2356 kcal (95% CI = 2279, 2440). The main moderate- and high-intensity activities among active people were sports (tennis, gymnastics, skiing), walking, climbing stairs, gardening, and (for men only) occupational activities. Conclusions. The definition of sedentarism outlined in this article can be reproduced in other populations, allows comparisons across studies, and provides preventive guidelines in that the activities most frequently performed by active people arts the ones most likely to be adopted by their sedentary peers.

Brenner, I. K. M., Thomas, S., & Shephard, R. J. (1998). Autonomic Regulation of the Circulation During Exercise and Heat Exposure: Inferences from Heart Rate Variability.  SPORTS MEDICINE: AN INTERNATIONAL JOURNAL 26 (2): 85.

Bylak, J., & Hutchinson, M. R.  Common Sports Injuries in the Young Tennis Player.  SPORTS MEDICINE: AN INTERNATIONAL JOURNAL 26 (2): 119.

Carpinelli, R. N.,  & Otto, R. M. (1998).   Strength Training: Single Versus Multiple Sets. SPORTS MEDICINE: AN INTERNATIONAL JOURNAL 26 (2): 73.

Fleischmann, K. E., Hunink, M. G. M., & Douglas, P. S. (1998).  Exercise Echocardiography or Exercise SPECT Imaging? A Meta-analysis of Diagnostic Test Performance. JAMA - JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 280 (10): 913-920.

Hallam, J., & Petosa, R.  (1998).  A Worksite Intervention to Enhance Social Cognitive Theory Constructs to Promote Exercise Adherence.  AMERICAN JOURNAL OF HEALTH PROMOTION 13 (1): 4-7.
    The Journal's Home Page is:

Harvey, P. W. J., Steele, J., & Jeffery, R. W. (1998). The Development and Evaluation of Lighten Up, an Australian Community-based Weight Management Program.  AMERICAN JOURNAL OF HEALTH PROMOTION 13 (1): 8-11.
    The Journal's Home Page is:

Huang, Y., Macera, C. A., & Kronenfeld, J. J. (1998). Physical Fitness, Physical Activity, And Functional Limitation In Adults Aged 40 And Older. MEDICINE AND SCIENCE IN SPORTS AND EXERCISE 30 (9): 1430-1435.
    The Journal Home Page is:

Kargotich, S., Goodman, C., & Morton, A. R. (1998). The Influence of Exercise-Induced Plasma Volume Changes on the Interpretation of Biochemical Parameters Used for Monitoring Exercise, Training and Sport.  SPORTS MEDICINE: AN INTERNATIONAL JOURNAL 26 (2): 101.

Mitchell, S. A. & Olds, R. S. (1999). Psychological And Perceived Situational Predictors Of Physical Activity: A Cross-Sectional Analysis. HEALTH EDUCATION RESEARCH 14(3): 305-313.

Peirce, N. S. (1999). Diabetes And Exercise. BRITISH JOURNAL OF SPORTS MEDICINE 33 (3):161-172.
    ABSTRACT: Exercise is frequently recommended in the management of type 1 and 2 diabetes mellitus and can improve glucose uptake by increasing insulin sensitivity and lowering body adiposity Both alone and when combined with diet and drug therapy physical activity can result in improvements in glycaemic control in type 2 diabetes. In addition, exercise can also help to prevent the onset of type 2 diabetes, in particular in those at higher risk, and has an important role in reducing the significant worldwide burden of this type of diabetes. Recent studies have improved our understanding of the acute and long term physiological benefits of physical activity, although the precise duration, intensity, and type of exercise have yet to be fully elucidated. However, in type I diabetes, the expected improvements in glycaemic control with exercise have not been clearly established. Instead significant physical and psychological benefits of exercise can be achieved while careful education, screening, and planning allow the metabolic, microvascular, and macrovascular risks to be predicted and diminished.

Pescatello, L. S., & Murphy, D.  (1998).  Lower Intensity Physical Activity Is Advantageous For Fat Distribution And Blood Glucose Among Viscerally Obese Older Adults. MEDICINE AND SCIENCE IN SPORTS AND EXERCISE 30 (9): 1408-1413.
    The Journal Home Page is:

Rowbottom, D. G., Keast, D., & Morton, A. R. (1998).  The Case History Of An Elite Ultra-Endurance Cyclist Who Developed Chronic Fatigue Syndrome.   MEDICINE AND SCIENCE IN SPORTS AND EXERCISE 30 (9): 1345-1349.
    The Journal Home Page is:

Sherwood, N. E., Morton, N., & Falkner, N. H. (1998).  Consumer Preferences in Format and Type of Community-based Weight Control Programs.  AMERICAN JOURNAL OF HEALTH PROMOTION 13 (1): 12-18.
    The Journal's Home Page is:

West, R. V. (1998). The Female Athlete: The Triad of Disordered Eating, Amenorhoea and Osteoporosis. SPORTS MEDICINE: AN INTERNATIONAL JOURNAL 26 (2): 63.


Other References

National Health Protection Survey of Beaches for the 2001 Swimming Season

Neighborhood Safety and the Prevalence of Physical Inactivity -- Selected States, 1996. Morbidity and Mortality Weekly Report, Vol. 48/No. 7, Feb. 26, 1999. View the full text of this week's MMWR as a web page at:     Physical inactivity is an important risk factor for premature morbidity and mortality, especially among high-risk populations. Although health-promotion programs have targeted high-risk groups (i.e., older adults, women, and racial/ethnic minorities) (1), barriers exist that may affect their physical activity level (2). Identifying and reducing specific barriers (e.g., lack of knowledge of the health benefits of physical activity, limited access to facilities, low self-efficacy, and environmental issues [2-6]) are important for efforts designed to increase physical activity. Concerns about neighborhood safety may be a barrier to physical activity (2,3). To characterize the association between neighborhood safety and physical inactivity, CDC analyzed data from the 1996 Behavioral Risk Factor Surveillance System (BRFSS) in Maryland, Montana, Ohio, Pennsylvania, and Virginia. This report summarizes the results of this analysis, which indicate that persons who perceived their neighborhood to be unsafe were more likely to be physically inactive.

Summerfield, Liane M.  Promoting Physical Activity and Exercise among Children. Physical inactivity has become a serious problem in the United States. More than half of U.S. adults do not meet recommended levels of moderate physical activity, and one-fourth engage in no leisure time physical activity at all (PHYSICAL ACTIVITY, 1996). Inactivity is more prevalent among those with lower income and education, and, beginning in adolescence, affects females more than males (NIH, 1995; Physical Activity, 1996). A pattern of inactivity, also known as sedentism, begins early in life, making the promotion of physical activity among children imperative. This Digest discusses the importance of and ways to foster activity and exercise in children. The full text of this ERIC Digest can be found at:

Surveillance for Waterborne-Disease Outbreaks --- United States, 1999--2000.  MMWR Vol. 51/No. SS-8, Nov 21, 2002.  Since 1971, CDC, the U.S. Environmental Protection Agency (EPA), and the Council of State and Territorial Epidemiologists (CSTE) have maintained a collaborative surveillance system for the occurrences and causes of waterborne-disease outbreaks (WBDOs).  This surveillance system is the primary source of data concerning the scope and effects of waterborne diseases on persons in the United States.  This summary includes data regarding outbreaks occurring during January 1999--December 2000 and previously unreported outbreaks occurring in 1995 and 1997.



1. 1996 Surgeon General’s Report. Given the facts of the report in the boxed issue, how would you go about making a case to a School Board to increase the daily amount of Physical Education? What allies would you try to bring on-side in your arguments?

2. Quality of Life. The poem about "The Healthiest Couple" alludes to the issues of quality versus quantity of life; health as a means to an end rather than an end in itself; the great human tragedy of dying without having really lived, whether it be 50 or 150 years; of not just adding years to one's life but life to one's years; and of wanting health as a means of living a full life for much more than survival. How do these issues relate to the difference between personal health and community health?

3. Fitness as fad or trend. The fitness boom is most observable among the affluent young in fashionable leotards, headbands and expensive jogging shoes. It is evident that there are more runners, walkers, tri-athletes, bicyclists, dancercizers, racquetball players, and those engaged in individual and team sports across all ages. These observations suggest that the fitness revolution is here to stay and looking more like a trend than a fad. Identify indicators of the fitness movement in their communities. How do these indicators vary by gender, socioeconomic status, age, and ethnicity?

4. Recreation resources. Identify recreation resources/ organizations in their own community. How many and what kinds of resources/organizations are publicly or privately supported? Visit a community recreation site to explore how these agencies plan for, market, implement, and evaluate their activities?

5. Age and physical activity. Explore physical activity by age. For example, how do child care centers, grade schools, high schools, work sites, and nursing homes or senior centers provide for physical activity? How does the kind of physical activity itself vary by site and what are the issues of involving people of different activities in physical activity?

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