Written by guest blogger, Jake Lynch, from Rails-to-Trails Conservancy.

In recent years Rails-to-Trails Conservancy (RTC) has seen trails evolve from being considered purely as recreational facilities to occupying a key role in the relationship between built environments and public health. But building the trails themselves is only half the battle. Longer-term work involves encouraging their use, investing residents and users with a sense of ownership, and making trails a natural, integral part of the community.

To facilitate this relationship, RTC staff must be creative, running programs that, at first glance, seem far removed from their trails mission. For example, RTC staff recently helped students at a D.C. school paint a colorful mural on a trailside wall, next to a vegetable garden. We brought along a fitness instructor who specialized in children’s activities, so the young artists took breaks from painting by running, stretching and racing along the trail. The event began a gradual process of familiarization that the trail is for them, that it connects to their school, and that it offers physical and personal freedom in an environment that can be restrictive. 

In Pittsburgh, RTC sponsors students from low-income neighborhoods to join the annual Sojourn bicycle tour. As training, volunteers from Bike Pittsburgh lead rides along local trails. To warm up, they do yoga. It’s a wonderful sight: A group of young black students in the Lion’s Pose as cyclists and joggers cruise by. Bike Pittsburgh also operates a Free Ride Recycled Bike Shop. In areas where being able to afford a bike is a major obstacle, creative initiatives like these have a real impact on the number of people riding for regular trips.

In Spartanburg, S.C., an educational scavenger hunt on the Mary Black Trail is increasing trail usage among students and seniors. Small train sculptures are hidden along the trail; kiosks, signage and iPods transmit historical facts and scavenger hunt clues. Organizers hope to bring regular educational trails trips into the school syllabus.

Across America, rail-trail organizations stage fun runs and races. An underlying purpose of these events is to establish the local trail in the collective mind of the community as a free fitness and recreation facility open to all. Staging events for people who are already active runners does little to address broader health goals, so trail organizers are innovating and expanding their reach. An annual fitness day on the Hurley Trail in New York includes a cycle-spin workshop and Zumba sessions. ‘Trail Mix’ on the W&OD Trail combines biking, walking and the area's Civil War history, plus live entertainment and sports clinics. The Morgana Run hosts "Walk a Hound, Lose a Pound."

Trails are the backbone of programs that provide incentives for students to ride or walk to school, ostensibly to reduce vehicle congestion at drop-off and pick-up times. RTC hosts Compton BikeFest, encouraging riding among children in inner-city communities, a focus of anti-obesity efforts. For trails advocates, the key to increasing physical activity is often to make it about anything but the exercise, promoting the financial savings, convenience, accessibility, freedom, social interaction and environmental aspects of riding and biking.  

Public park and recreation agencies and school districts in many areas have utilized Joint Use Agreements (JUA) for years. The National Policy & Legal Analysis Network to Prevent Childhood Obesity (NPLAN) "defines a JUA as a formal agreement between two separate government entities - stating terms and conditions for shared use of public property or facilities." Pooling of resources allows for more effective use of government dollars, which in today's economy takes on even greater meaning as well as a heightened sense of urgency. Groups advocating for physical activity have recently begun encouraging more towns, cities and counties to consider such agreements as a way to increase the number of physical activity opportunities for their residents.

Consider the following... School playgrounds are open to the community on weekends in San Francisco as a result of a joint use agreement between the school district and the city. The City of Seattle took things a bit further... they designed and implemented a program that centralized scheduling of both school and recreation facilities, which streamlined the reservation policy and increased access. In several communities, schools and cities have combined their resources to build new recreation facilities that serve the needs of both the schools and the community (NPLAN).

The National Physical Activity Plan includes JUAs as important strategies in both the Education sector and the Parks, Fitness Recreation and Sport (PFRS) sector. The Make the Move Report - 2010-2011 National Implementation of the U.S. Physical Activity Plan lists increasing the number of JUAs by 10% over the next 5 years as a priority for the PRFS sector. The President's Council on Fitness, Sports and Nutrition is co-leading this strategy with the National Recreation and Park Association.

I encourage advocates to look beyond government though for JUAs and to consider the possibility of public-private agreements. The Wheaton Park District used an innovative approach to increase their number of (much in demand) soccer fields. A large corporate campus sat at the edge of park district and had plenty of flat (this was Illinois!), green space that was there purely for its aesthetic value. The two organizations signed an agreement that stated the park district would mow the grass in return for its use as soccer fields evenings and weekends. I dare say there are many possibilities like this across the country.

Perhaps there is a private health club located near a school. Use of the club may be sparse during the day... what a great opportunity for a PE class! Maybe there's a camp nearby used only in the summer... strike a deal for use of its athletic facilities. Many places of worship even have recreational facilities. The possibilities are endless to increase spaces and places for people of all ages to engage in physical activity - if you just think the outside the box a bit!

What kinds of unique joint use agreements can you think of? Are there facilities in your own community that you could see working with to increase the opportunities for physical activity?

Inattentiveness, procrastination, fidgetiness, and disorganized work habits are just a few of the symptoms of ADHD. For a child with ADHD, such behaviors impair functioning at school, home, and their ability to maintain relationships with peers. The cause of ADHD is largely unknown and likely to be a multi-factorial interplay between genetic and environmental influences. Current strategies for management include medications and intensive behavioral therapy which are not optimal for long term management of the disorder.

Can physical activity help symptoms of ADHD? There is burgeoning research in this area that suggests this may be the case. A recent review paper published by Jeffery M. Halperin and colleagues from Queens College of the City University of New York, in Neuroscience and Behavioral Reviews, January 2011, suggests ADHD in children should be viewed within the context of a “developmental trajectory” rather than a fixed medical condition. As such, ADHD can be modified by environmental influences, including exercise. Individuals with ADHD are never cured, but they can compensate. Environmental influences, including exercise, may affect the degree of later brain development and hence determine the extent to which an individual can compensate.

Functional magnetic resonance imaging (fMRI) scans of the brains of children show that exercise increases activity in the frontal lobes, which are responsible for executive function (see USA Today article). The executive functions consist of processes responsible for planning, rule acquisition, initiating appropriate actions/inhibiting inappropriate actions, and selecting relevant sensory information. ADHD is a disorder of executive function. In an NIH funded study performed by Catherine Davis and colleagues at the Medical College of Georgia, on 94 sedentary children randomized to a high dose exercise intervention group, found improvement in planning scores (i.e., executive function) in the high dose group compared to controls. 

Studies are underway to determine the optimal frequency and amount of physical activity appropriate for children with ADHD. There is some consensus however, that certain types of physical activities may be more beneficial in children with ADHD (see article). Activities that require memorization and sequencing of behaviors help focus attention and repeat learned movement patterns, e.g., yoga, martial arts, dance/ballet, gymnastics, swimming and team sports. One study of the brains of judo players (adults) by Jacini and colleagues found significantly higher volume of gray matter in the frontal, parietal, occipital, temporal, and cerebellar regions of the brains of judo players versus controls. Interestingly, neuroimaging studies have shown reduced volume of the frontal, posterior, and cerebellar areas of brains of children with ADHD.

There is also evidence that physical activity outdoors may be more beneficial for children with ADHD. Dr. Frances Kuo from the University of Illinois found that green outdoor settings (green backyard, park, or neighborhood space) appeared to reduce the symptoms of ADHD in children compared to the same activities performed in indoor settings AND built outdoor settings (concrete areas, not much green).  Lastly, in July 2010, Yale Researcher, Dr. David Katz published preliminary results of the ABC Fitness Program (Activity Bursts in the Classroom) which focuses on physical activity during the school day.  The study compared an intervention group (schools that incorporated bursts of physical activity throughout the day) versus a control group. Preliminary results indicated that medication use for ADHD decreased in the intervention group. Green settings for playgrounds at schools, physical activity in the morning before class (tai chi on the lawn anyone?), and incorporating physical activity during the day in the classroom, may be just the prescription needed to help children overcome the hurdles of ADHD.

Thanks to Farzana L. Walcott, MD, MPH, for submission of this post.