IntroductionHealth disparities exist between rural and urban residents; in particular, rural residents have higher rates of chronic diseases and obesity. Evidence supports the effectiveness of policy and environmental strategies to prevent obesity and promote health equity. In 2009, the Centers for Disease Control and Prevention recommended 24 policy and environmental strategies for use by local communities: the Common Community Measures for Obesity Prevention (COCOMO); 12 strategies focus on physical activity. This review was conducted to synthesize evidence on the implementation, relevance, and effectiveness of physical activity–related policy and environmental strategies for obesity prevention in rural communities.MethodsA literature search was conducted in PubMed, PsycINFO, Web of Science, CINHAL, and PAIS databases for articles published from 2002 through May 2013 that reported findings from physical activity–related policy or environmental interventions conducted in the United States or Canada. Each article was extracted independently by 2 researchers.ResultsOf 2,002 articles, 30 articles representing 26 distinct studies met inclusion criteria. Schools were the most common setting (n = 18 studies). COCOMO strategies were applied in rural communities in 22 studies; the 2 most common COCOMO strategies were “enhance infrastructure supporting walking” (n = 11) and “increase opportunities for extracurricular physical activity” (n = 9). Most studies (n = 21) applied at least one of 8 non-COCOMO strategies; the most common was increasing physical activity opportunities at school outside of physical education (n = 8). Only 14 studies measured or reported physical activity outcomes (10 studies solely used self-report); 10 reported positive changes.ConclusionSeven of the 12 COCOMO physical activity–related strategies were successfully implemented in 2 or more studies, suggesting that these 7 strategies are relevant in rural communities and the other 5 might be less applicable in rural communities. Further research using robust study designs and measurement is needed to better ascertain implementation success and effectiveness of COCOMO and non-COCOMO strategies in rural communities.

Based on this analysis, we showed that PE is frequently introduced, yet the proportion of bills with evidence-based elements is low. Future research is needed to provide the types of evidence required for development of quality PE legislation.

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Context Built environment-focused interventions and policies are recommended as sustainable approaches for promoting physical activity. Physical activity has not traditionally been considered in land use and transportation decision making. Effective collaboration with non-public health partners requires knowledge of their perceived barriers to consideration of physical activity in decision making. Objective This study aimed to 1) identify barriers to the consideration of physical activity in community design and planning decisions among municipal decision makers and 2) explore differences in these barriers among a wide range of job functions and departments in a geographically diverse sample. Design A web-based survey was conducted among municipal officials in 94 cities and towns with populations of at least 50,000 residents in eight states. Participants 453 municipal officials from public health, planning, transportation/public works, community and economic development, parks and recreation, city management, and municipal legislatures responded to the survey. Main Outcome Measures Five barriers to consideration of physical activity in community design and layout were assessed. Results The most common barriers included lack of political will (23.5%), limited staff (20.4%) and lack of collaboration across municipal departments (16.2%). Fewer participants reported opposition from the business community or residents as barriers. Compared to other professionals, public health department personnel were more likely to report the barriers of limited staff and lack of collaboration across municipal departments. They were also more likely to report lack of political will compared to city managers or mayors and municipal legislators. Conclusions Barriers to increasing consideration of physical activity in decision making about community design and layout are encouragingly low. Implications for public health practice include the need to strategically increase political will despite public health staffing constraints and perceived lack of collaboration with relevant departments such as planning and public works/transportation.

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