From a public health perspective, a cost-benefit analysis of using bike/pedestrian trails in Lincoln, Nebraska, to reduce health care costs associated with inactivity was conducted. Data was obtained from the city's 1998 Recreational Trails Census Report and the literature. Per capita annual cost of using the trails was U.S.$209.28 ($59.28 construction and maintenance, $150 of equipment and travel). Per capita annual direct medical benefit of using the trails was $564.41. The cost-benefit ratio was 2.94, which means that every $1 investment in trails for physical activity led to $2.94 in direct medical benefit. The sensitivity analyses indicated the ratios ranged from 1.65 to 13.40. Therefore, building trails is cost beneficial from a public health perspective. The most sensitive parameter affecting the cost-benefit ratios were equipment and travel costs; however, even for the highest cost, every $1 investment in trails resulted in a greater return in direct medical benefit.
Berrigan, D., & Troiano, R. P. (2002). The association between urban form and physical activity in U.S. adults. American Journal of Preventive Medicine, 23(Suppl 2), 74-79.
2.
Brown, W. J., Mishra, G., Lee, C., & Bauman, A. (2000). Leisure time physical activity in Australian women: Relationship with well-being and symptoms. Research Quarterly for Exercise and Sport, 71(3), 206-216.
3.
Brownson, R. C., Houseman, R. A., Brown, D. R., Jackson-Thompson, J., King, A. C., Malone, B. R., et al. (2000). Promoting physical activity in rural communities: walking trail access, use, and effects. American Journal of Preventive Medicine, 18(3), 235-241.
4.
Centers for Disease Control and Prevention. (2001)Physical activity trends—United States, 1990-1998. Morbidity and Mortality Weekly Report, 50, 166-169.
5.
Colditz, G. A. (1999). Economic costs of obesity and inactivity. Medicine and Science in Sports and Exercise, 31(11 Suppl), S663-S667.
6.
Corti, B., Donovan, R. J., & Holman, C. D. (1997). Factors influencing the use of physical activity facilities: Results from qualitative research. Health Promotion Journal of Australia, 7, 16-21.
7.
Craig, C. L., Brownson, R. C., Craag, S. E., & Dunn, A. L. (2002). Exploring the effects of the environment on physical activity: A study examining walking to work. American Journal of Preventive Medicine, 23(2 Suppl), S36-S43.
8.
Dunn, A. L., Marcus, B. H., Kampert, J. B, Garcia, M. E., Kohl, H. W., III, & Blair, S. N. (1999). Comparison of lifestyle and structured interventions to increase physical activity and cardiorespiratory fitness: A randomized trial. Journal of the American Medical Association, 281, 327-334.
9.
Handy, S. L., Boarnet, M. G., Ewing, R., & Killingsworth, R. E. (2002). How the built environment effects physical activity: Views from urban planning. American Journal of Preventive Medicine, 23(2 Suppl), S64-S73.
10.
Hassmen, P., Koivula, N., & Uutela, A. (2000). Physical exercise and psychological well-being: A population study in Finland. Preventive Medicine, 30, 17-25.
11.
Hatziandreu, E. I., Koplan, J. P., Weistein, M. C., Caspersen, C. J., & Warner, R. E. (1988). A cost-effectiveness analysis of exercise as a health promotion activity. American Journal of Public Health, 8(11), 1417-1421.
12.
Jones, T. F., & Eaton, C. B. (1994). Cost-benefit analysis of walking to prevent coronary heart disease. Archives of Family Medicine, 3, 703-710.
13.
Kahn, E. B., Ramsey, L. T., Brownson, R. C., Heath, G. W., Howze, E. H., Powell, K. E., et al. (2002). The effectiveness of interventions to increase physical activity: A systematic review. American Journal of Preventive Medicine, 22(4 Suppl), S73-S107.
14.
Keeler, E. B., Manning, W. G., Newhouse, J. P., Sloss, E. M., & Wasserman, J. (1989). The external costs of sedentary life-style. American Journal of Public Health, 79(8), 975-980.
15.
King, A. C. (1991). Community intervention for promotion of physical activity and fitness. Exercise and Sport Science Reviews, 19, 211-259.
16.
King, A. C., Jeffery, R. W., Fridinger, F., Dusenbury, L., Provence, S., Hedlund, S. A., et al. (1995). Environmental and policy approaches to cardiovascular disease prevention through physical activity: Issues and opportunities. Health Education Quarterly, 22, 499-511.
17.
King, A. C., Blair, S. N., Bild, D. E., Dishman, R. K., Dubbert, P. M., Marcus, B. S., et al. (1992). Determinants of physical activity and interventions in adults. Medicine and Science in Sports and Exercise, 24(6 Suppl), S221-S223.
18.
Linenger, J. M., Chesson, C. V., II, & Nice, D. S. (1991). Physical fitness gains following simple environmental change. American Journal of Preventive Medicine, 7, 298-310.
19.
Lincoln Recreational Trails Census Report. (1998, October). Great Plains Trials Network. Available at www.bikped.com/gptnnews5/
20.
Lowensteyn, I., Coupal, L., Zowall, H., & Grover, S. A. (2000). The cost-effectiveness of exercise training for the primary and secondary prevention of cardiovascular disease. Journal of Cardiopulmonary Rehabilitation, 20, 147-155.
21.
Martinez, M. E., Giovannucci, E., Spiegelman, D., Hunter, D. J., Willet, W. C., & Colditz, G. A. (1997). Leisure-time physical activity, body size, and colon cancer in women. Journal of the National Cancer Institute, 89, 948-954.
22.
Mettler, M. M., Stone, W. J., Herrick, A. B., & Klein, D. A. (2000). Evaluation of a community-based physical activity campaign via the transtheoretical model. Health Promotion Practice, 1, 351-359.
23.
Nicholl, J. P., Coleman, P., & Brazier, J. E. (1994). Health and healthcare costs and benefits of exercise. PharmacoEconomics, 5(2), 109-122.
24.
Owen, N., Leslie, E., Salmon, J., & Fotheringham, M. J. (2000). Environmental determinants of physical activity and sedentary behavior. Exercise and Sport Science Reviews, 28, 153-158.
25.
Pratt, M., Macera, C. A., & Wang, G. (2000). Higher direct medical costs associated with physical inactivity. Physician and Sports Medicine, 28(10), 63-70.
26.
Robertson, M. C., Devlin, N., Gardner, M. M., & Campbell, A. J. (2001). Effectiveness and economic evaluation of a nurse delivered home exercise program to prevent falls, 1: Randomised controlled trial. British Medical Journal, 322, 697-701.
27.
Robertson, M. C., Devlin, N., Scuffham, P., Gardner, M. M., Buchner, D. M., & Campbell, A. J. (2001). Economic evaluation of a community based exercise program to prevent falls. Journal of Epidemiology and Community Health, 55, 600-606.
28.
Sallis, J. F., Bauman, A., & Pratt, M. (1998). Environmental and policy interventions to promote physical activity. American Journal of Preventive Medicine, 15, 379-397.
29.
Sallis, J. F., Hovell, M. F., Hofstetter, C. R., Elder, J. P., Hackley, M., Caspersen, C. J., et al. (1990). Distance between homes and exercise facilities related to frequency of exercise among San Diego residents. Public Health Reports, 105, 179-185.
30.
Sallis, J. F., Johnson, M. F., Calfas, K. J., Caparosa, S., & Nichols, J. F. (1997). Assessing perceived physical environmental variables that may influence physical activity. Research Quarterly for Exercise and Sport, 68, 345-351.
31.
Sevick, M. A., Bradham, D. D., Muender, M., Chen, G. J., Enarson, C., Dailey, M., et al. (2000). Cost-effectiveness of aerobic and resistance exercise in seniors with knee osteoarthritis. Medicine and Science in Sports and Exercise, 32(9), 1534-1540.
32.
Task Force on Community Preventive Services. (2002). Recommendations to increase physical activity in communities. American Journal of Preventive Medicine, 22(4 Suppl), S67-S72.
33.
U.S. Department of Health and Human Services. (1996). Physical activity and health: A report of the surgeon general. Atlanta, GA: Centers for Disease Control and Prevention.
