For Health

BUILDING EVIDENCE

FOR HEALTH

Research Summary: Active Design

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Contributors:

Adam Meier, Harvard T.H. Chan School of Public Health
Kathryn Perry, Harvard T.H. Chan School of Public Health

What is Active Design?

Active design is a set of building and design approaches that promote physical activity and health. Buildings are of great importance in promoting health because the average American spends 90% of their time indoors.1 In addition to spending more time indoors, economic, technological, and social changes have substantially increased the proportion of time people spend inactive at work and in leisure activities.2,3 According to the Centers for Disease Control and Prevention, today 80% of Americans do not meet the 2008 Physical Activity Guidelines of 150 minutes per week of moderate physical activity and two or more days of muscle-strengthening activity necessary to maintain health and fitness.4

Framing Question for Approaching Active Design: “Does this building element outsource movement, or facilitate movement?” (i.e. an escalator outsources movement between floors to mechanical systems).

The ways in which we choose to create, construct, operate, and engage with buildings can either detract from or enhance individual and group health and wellbeing. Thoughtful active building design, with a focus on supporting physical activity can help occupants incorporate more physical activity into their daily activities and thereby support better health outcomes.

How does physical activity impact health?

Regular physical activity is a foundation of good health. A significant body of research illustrates the many health benefits, including that regular physical activity helps people to maintain a healthy weight; combats chronic health conditions and diseases; improves mood; boosts energy; and promotes better sleep.5,6 Conversely, a high proportion of daily sedentary activity and long duration of sedentary activity are both associated with all-cause mortality.7 In their 2012 study, Lee et al. show that 9% of premature mortality, or more than 5.3 million of the 57 million deaths that occurred worldwide in 2008 could be attributed to physical inactivity. Specifically, they show that physical inactivity is estimated to cause 6% of the burden of disease from coronary heart disease; 7% Type 2 diabetes; 10% breast cancer; and 10% of colon cancer. These health impacts are of similar magnitude to both smoking and obesity.8

How does active design impact health?

Active design impacts health by helping building occupants integrate regular physical activity into their day. Research on specific active design interventions is still emerging. Encouragingly, the research that has been completed shows that active design can have a significant impact on increasing the physical activity of building occupants. The main body of evidence currently comes from broader research on the health impacts of physical activity. An estimate of the comprehensive public health benefits from active design in buildings has not been completed to date; however, globally, if “inactivity was decreased by just 10% or 25%, more than 533,000 and more than 1.3 million deaths, respectively, could be averted annually”.8

Studies focused on active design interventions show that regular stair climbing provides significant cardiovascular benefits.9 Further, by providing access to more opportunities for physical activity and Editor in Chief | Joseph G. Allen, Harvard T.H. Chan School of Public Health Framing Question for Approaching Active Design: “Does this building element outsource movement, or facilitate movement?” (i.e. an escalator outsources movement between floors to mechanical systems). structural nudges that increase and enhance movement active design can improve health outcomes. Additional evidence shows that “point-of-decision” prompts effectively encourage stair use and suggest that “creation of or enhanced access to places for physical activity” can also be effective in increasing physical activity.10 Circulatory spaces that are designed to be aesthetically and functionally inviting and safe can positively motivate health behaviors.12 Building occupants who have relocated from conventional buildings to buildings with active design elements have shown increased daily movement and use of stairs, measured by accelerometers and self-reported survey responses.11,12 Active design in buildings has significant potential to increase occupant’s daily physical activity and thereby improve health.

What can I do?

Architects, designers, and building managers can help building occupants to achieve healthy levels of physical activity by implementing active design best-practices in new construction, existing buildings, and organizational structures. Many active design elements help make healthier choices the default for building occupants, while making unhealthy choices more difficult, an approach supported in public health research.13 As a primary step, design should be oriented for individuals of all mobility levels and compliant with building codes.

New Construction and Substantial Renovations

The design and development phase of constructing new buildings provides a blank pallet for creating spaces that facilitate and encourage movement. Existing buildings planning for substantial renovations, can approach active design with similar principles as new construction. Where possible, integrate and emphasize accessible and welcoming circulation elements, add interior building amenities that facilitate movement, and develop exterior spaces that are pedestrian and active-transportation friendly.

The Center for Active Design (CfAD) is the leading organization working to develop tools for incorporating active design principles into buildings and communities. Frameworks, guidelines, and certifications led or informed by CfAD include NYC’s Active Design Guidelines,14 Fitwel Certification (CfAD) (developed in partnership with CDC and GSA), Active Design Supplement: Promoting Safety,17 and Active Design Verified.16 Details on specific considerations for integrating active design elements can be found in these resources.


Recommendations for building-based active design interventions most commonly focus on:

  • Circulation system components such as corridors, stairs, interior spaces, and lobbies are the primary building elements where movement – typically walking – will occur
  • The locations of common building functions and supportive walking routes can encourage brief bouts of walking to common spaces, whether in residential, commercial, retail, or other.
  • Building amenities such as shower and locker room facilities, protected bike cages, exercise rooms, and bottle-filling stations support physical activity and active commuting.
  • Exterior building spaces can contribute to physical activity via the presence of bike and/or walking paths, locating in walkable neighborhoods, decks, and rooftop gardens.
  • Enhancing safety and comfort through active design elements by ensuring adequate visibility, creating enhanced security, and clearly communicating critical information.

Existing Buildings

Low-cost interventions such as directional signage, motivational prompts, and place-making decorations can be effectively adapted to existing buildings. Point-of-decision prompts that are context-specific and tailored to the target audience of a building are shown to be effective at increasing physical activity, particularly with guiding decisions to take stairs.18-21 Skip-stop elevators which only stop on certain floors can also increase physical activity.22 Other considerations include furniture, fixtures, spatial layout, and decorations (novelty, and engagement with the space), that can provide low-cost opportunities to enhance new and existing building spaces in ways that encourage movement. For example; a meta-analysis by Saeidifard, et al. showed that standing desks increase energy expenditure compared with sitting.23

Organizational Management

Occupant engagement programs provide anecdotal and self-reported evidence to support persistence of behavior change and norm-reframing to encourage physical activity. While engagement programs themselves are not building-based, they often rely on building elements and can be designed to enhance the utilization of active design elements. Participants of occupant engagement programs report increases in opting to incorporate physical activity such as taking the stairs, organizing walking-meetings, and active transportation into daily life.24

References

  1. U.S. Environmental Protection Agency. Report to Congress on Indoor Air Quality: Volume
  2. EPA/400/1-89/001C. Washington, DC. 2. Owen N, Sparling PB, Healy GN, Dunstan DW, Matthews CE. Sedentary Behavior: Emerging Evidence for a New Health Risk. Mayo Clinic Proceedings. 2010;85(12):1138-1141. doi:10.4065/mcp.2010.0444.
  3. Church TS, Thomas DM, Tudor-Locke C, et al. Trends over 5 Decades in U.S. Occupation-Related Physical Activity and Their Associations with Obesity. Lucia A, ed. PLoS ONE. 2011;6(5):e19657. doi:10.1371/journal. pone.0019657.
  4. Centers for Disease Control and Prevention. Physical Activity Basics. 2015. Retrieved from: https://www.cdc.gov/ physicalactivity/basics/index.htm
  5. Mayo Clinic. Exercise: 7 Benefits of Regular Physical Activity. 2016. Retrieved from: https://www.mayoclinic.org/ healthy-lifestyle/fitness/in-depth/exercise/art-20048389.
  6. Centers for Disease Control and Prevention. Physical Activity and Health. 2015. Retrieved from: https://www.cdc. gov/physicalactivity/basics/pa-health/index.htm.
  7. Katzmarzyk PT, Church TS, Craig CL, Bouchard C. Sitting Time and Mortality from all Causes, Cardiovascular Disease, and Cancer. Med Sci Sports Exerc. 2009;41(5):998-1005
  8. Lee, I-Min et al. Effect of Physical Inactivity on Major Non-Communicable Diseases Worldwide: An Analysis of Burden of Disease and Life Expectancy. The Lancet, Volume 380, Issue 9838. 2012, 219 – 229.
  9. Boreham CAG, Wallace WFM, Nevill A. Training Effects of Accumulated Daily Stair-Climbing Exercise in Previously Sedentary Young Women. Preventive Medicine. 2000; 30: p. 277-281
  10. Kahn EB, et al. The Effectiveness of Interventions to Increase Physical Activity. A Systematic Review. Am J Prev Med. 2002; 22(suppl 4):73–107.
  11. Jancey, J. M., et al. Workplace Building Design and Office-Based Workers’ Activity: A Study of a Natural Experiment. Australian and New Zealand Journal of Public Health. 2016; 40: 78–82 http://onlinelibrary.wiley. com/doi/10.1111/1753-6405.12464/full
  12. Garland Elizabeth, et al. One Step at a Time Towards Better Health: Active Design in Affordable Housing. Environmental Justice. 2014; 7(6): 166-171. https://doi.org/10.1089/env.2014.0031
  13. Stokols D, et al. Increasing the Health Promotive Capacity of Human Environments. Am J Health Promot. 2003; 18:4–13
  14. City of New York (NYC). Active Design Guidelines: Promoting Physical Activity and Health in Design. 2010. https://centerforactivedesign.org/guidelines/
  15. The Center for Active Design (CfAD). Fitwel. https://fitwel.org
  16. Partnership for a Healthier America (PHA), The Center for Active Design. Active Design Verified (ADV). 2015. https://www.ahealthieramerica.org/articles/active-design-verified-3
  17. Johns Hopkins Center for Injury Research and Policy, NYC Department of Health and Mental Hygiene, Society for Public Health Education. Active Design Supplement: Promoting Safety, Version 2, 2013. https:// centerforactivedesign.org/promotingsafety
  18. Brownell KD, Stunkard AJ, Albuam JM. Evaluation and modification of exercise patterns in the natural environment. American Journal of Psychiatry. 1980. 137(12), 1540-1545.
  19. Soler RE, et al, for the Task Force on Community Preventive Services Point-of-Decision Prompts to Increase Stair Use: A Systematic Review Update. Am J Prev Med. 2010;38(suppl 2):S292–300. [PubMed]
  20. Nocon M, et al. Increasing Physical Activity with Point-of-Choice Prompts: A Systematic Review. Scand J Public Health. 2010;38:633–38. [PubMed]
  21. Webb OJ, et al. A Statistical Summary of Mall-Based Stair-Climbing Interventions. J Phys Act Health. 2011;8:558–65. [PubMed]
  22. Nicoll G and Zimring C. The effect of Innovative Building Design on Physical Activity. Journal of Public Health Policy. 2009; 30 (supplement 1): p. S111–S123.
  23. Saeidifard, F., et al. Difference of Energy Expenditure While Standing versus Sitting: A Systematic Review and Meta-Analysis. American Heart Association. Circulation. 2017;136:A20539
  24. Heath, Gregory W et al. “Evidence-Based Intervention in Physical Activity: Lessons from around the World.” Lancet (London, England) 380.9838 (2012): 272–281.