Date Published: June 11, 2019
Publisher: Public Library of Science
Author(s): Léonie Uijtdewilligen, Clarice Nhat-Hien Waters, Su Aw, Mee Lian Wong, Angelia Sia, Anbumalar Ramiah, Michael Wong, Falk Müller-Riemenschneider, Joe Robert Nocera.
This mixed-methods study aims to inform the development of a ‘Park Prescription’ intervention, including face-to-face counseling on physical activity and park use and providing weekly structured exercise sessions in the park to promote physical activity. Participants aged 40–65 years were recruited from regional health screening events in Singapore where they completed a questionnaire (N = 97) and consented to focus group (FG) participation (N = 16). The questionnaire assessed current park use, and the type, duration, and intensity of park-based activities that would be of interest. FGs explored the barriers and facilitators of physical activity (in parks). Short interviews (N = 16) with ‘doers’, i.e., people already engaging in park-based physical activity, identified motivational factors and ways to overcome common barriers. Participants acknowledged the health benefits of parks and valued them because of their pleasant landscapes, greenery and facilities. However, few participants engaged in physical activity at the parks, because they were too busy or too tired. Participants mostly indicated doing informal activities, such as walking, cycling or playing traditional Asian games when using the parks for exercise. A variety of low-to-moderate intensity park-based activities such as walking, cycling or aerobics were of interest to participants who expressed the willingness to engage in structured exercise sessions on weekday evenings or weekend mornings. Strategies to increase physical activity in parks included: encourage planning, create social support, identify alternatives for bad weather, improve proximity/accessibility to parks and park safety. The effectiveness of the Park Prescription intervention in promoting physical activity, park use, as well as physical and mental well-being will be tested in a one-year Randomized Controlled Trial.
Being physically inactive, defined as accumulating less than 150 minutes of moderate- to vigorous-intensity physical activity per week, is a significant risk factor for developing non-communicable, chronic diseases such as stroke, diabetes, and cancer [1–3]. Physical inactivity is also one of the 10 leading risk factors for global mortality . The World Health Organization (WHO) estimated the worldwide physical inactivity prevalence among adults to be 23.3%, with varying percentages across WHO regions; from 32.4% in the Americas to 14.7% in South-East Asia . But also within these regions prevalence rates of physical inactivity differ. For example, research among a Singapore sample showed that over 26% of adults were not sufficiently physically active and only 24% engaged in regular leisure-time physical activity . To develop evidence-based interventions, countries have been monitoring their populations’ physical activity levels more closely and research on the correlates of physical activity has increased, also among low- and middle-income countries  where the health burden of non-communicable diseases is disproportionately high compared to high-income countries . There is a high demand for novel and effective programs to mitigate the global pandemic of physical inactivity.
To understand participants’ park use, their physical activity behavior (in general and with the focus on park-based physical activities) and common barriers and facilitators to physical activity engagement and visiting parks, this mixed-method sequential explanatory study  includes three inter-related components:
Fig 1 presents the number of people who joined one of the health screening events where we recruited for this study. The figure also reflects eligibility and participation rates of those who were invited to participate in the Park Prescription Study.
This mixed-methods study aimed to inform the development of a Park Prescription intervention, including a face-to-face counseling on physical activity and park use and providing weekly structured exercise sessions in the park to promote physical activity. We managed to recruit a sample of Singaporean adults of low socio-economic status. Participants who completed the questionnaire had low educational levels and all of them lived in public housing (data not shown). A recent review among Singapore citizens showed that staying in public rental housing was an important risk marker for lower participation in health screenings, preference for alternative medicine practitioners and poorer health outcomes . Our results are thus particularly interesting in the context of a hard to reach population most in need of health promotion efforts .
This mixed-methods study showed that community-dwelling individuals in Singapore expressed an intention to visit parks often and be active there, but only few of them do so. The identified important barriers (e.g., being too busy, lack of social support, weather-related concerns and the fear of injuring oneself) and facilitators (e.g., park proximity and accessibility, physical activities of interest to the target group) to physical activity and park use will inform the design of a Park Prescription intervention. The effectiveness of the Park Prescription intervention in promoting physical activity, park use, as well as physical and mental well-being will be tested in a one-year Randomized Controlled Trial.