709402

research-article2017
RSH0010.1177/1757913917709402Current Topics & OpinionsCurrent Topics & Opinions

Current Topics & Opinions

A potential role for outdoor,

interactive spaces as a healthcare
intervention for older persons
With the elderly population increasing globally, the importance of a physically activity, social interaction and improved
active lifestyle which can promote health and reduce disability is becoming cognitive function.5–9 Outdoor interactive
increasingly apparent. Chelsea Kershaw, Jacqueline McIntosh, Bruno spaces, such as appropriately designed
Marques and Jon Cornwall from Victoria University of Wellington, or equipped community parks, therefore
present an opportunity for promoting
Lee Stoner from University of North Carolina and Phil Wood from Ministry
physical activity and combating ageing-
of Health, Wellington argue that physical activity should be promoted
associated morbidities and loss of
among older persons through the development of appropriate outdoor, independence in older persons.3
interactive spaces in an attempt to offset chronic diseases and reduce Interactive landscapes can be designed
some of the pressure on our healthcare systems. to incorporate specific activities that are
targeted at facilitating improvements in
common morbidities, such as falls, by
spaces is endorsed by the World Health incorporating strength and balance
Organization.1 This article argues that training exercises to improve ankle
physical activity should be promoted flexibility.10,11 However, while the
among older persons through the incorporation of age-appropriate physical
development of age-appropriate outdoor, activity options within interactive outdoor
interactive landscapes into public spaces is a necessary design element,
spaces. Such landscapes can be further evidence is required to guide and
incorporated in a cost-effective manner, support the implementation of such
may offset the development of chronic areas.
diseases, are environmentally sustainable
Globally, the elderly population is and may reduce some of the burden
predicted to triple from 2010 to 2050, currently placed on struggling healthcare Where is The Evidence for
producing a cohort of approximately systems. The Effectiveness of
1.5 billion aged citizens and expanding Outdoor Spaces as A
the number of individuals over 60 years A Potential Role for Healthcare Intervention for
of age from 8% to 16% of the Age-Specific Outdoor Older Persons?
population.1 Advanced age is typically Interactive Spaces Despite the implementation of outdoor
associated with the development of Participating in physical activity improves interactive spaces specifically catering for
chronic diseases, many of which can be personal health and overall wellbeing, older persons in some parts of the world,
attributed to the way we, as a society, reduces stress and improves some there is limited published research
are ageing.2 Increased rates of chronic psychological exploring design
diseases, in addition to placing stress on disorders such as parameters that
existing healthcare systems, can lead to dementia and
Participating in physical influence what
disability and loss of independence. New depression.
activity improves personal targeted interactive
and effective strategies are therefore Evidence suggests
health and overall outdoor spaces for
required to address these issues using these improvements
wellbeing, reduces stress older persons
population-based approaches. are enhanced when
and improves some actually look like,
It is widely accepted that a physically physical activities
psychological disorders where in our
active lifestyle can promote health and are conducted in
such as dementia and communities they
reduce disability. Around the world, free outdoor spaces. 3 depression should be located
outdoor fitness zones are rising in Furthermore, and what sort of
popularity and becoming increasingly numerous studies demonstrate the age-specific factors should be
prevalent in public parks,3,4 and the benefits of outdoor spaces for elderly acknowledged within design schema.7,12
creation and utilisation of such outdoor people, including increased physical Current research on outdoor interactive

212  Perspectives in Public Health l July 2017 Vol 137 No 4 Copyright © Royal Society for Public Health 2017
SAGE Publications
ISSN 1757-9139 DOI: 10.1177/1757913917709402

spaces for older persons is limited to a
handful of case studies which assess
elderly perceptions of outdoor fitness
equipment, preliminary research from
playground suppliers and studies
identifying the need for (or success of)
installations.4,10,13–15 Furthermore, much
of the outdoor equipment marketed as
suitable for older persons is not always
user-friendly for this demographic.14
Robust empirical studies indicating
appropriate design parameters are yet to
be delivered to guide development of
age-appropriate interactive outdoor
equipment.
There is also limited research on
human factors, including motivational
strategies, social acceptability and
inclusivity, or how to ensure outdoor
interactive spaces are ethnically, culturally
or socially appropriate.7 Other variables
that may influence their uptake such as
gender, socio-economic status, disability
and capability, all which may contribute
to use by older age-groups, also require
exploration. In addition, there are limited
studies exploring the ongoing utilisation
of outdoor interactive spaces by this
older demographic. Successful and
References
1. World Health Organization and National
Institute on Aging (eds). Global health and
aging. Report. Geneva: WHO, 2011.
2. Wadsworth D, Gleason M, Stoner L. Can
sedentary behaviour be considered a cultural
maladaptation?. Perspectives in Public Health
2014; 134(1): 20–1.
3. Elwell H, Shulaker B, Rippon J, Wood R.
Strategic and integrated planning for healthy,
connected cities: Chattanooga case study.
Preventive Medicine. Epub 2016 November
12. DOI: 10.1016/j.ymed.2016.11.002.
4. Cranney L, Phongsavan P, Kariuki M et al.
Impact of an outdoor gym on park users’
physical activity: A natural experiment. Health
& Place 2016; 37: 26–34.
5. Grant B. Time for action: Advocacy for physical
activity in later life. Asia-Pacific Journal of Health,
Sport and Physical Education 2010; 1: 13–9.
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CURRENT TOPICS & OPINIONS
enduring engagement with spaces is
therefore likely to be a challenge because
while evidence suggests older persons
are a main user group of public green
space, current levels of engagement are
low.13,14 As such, the design of outdoor
interactive spaces must incorporate
factors known to influence adherence
issues and engagement to support their
successful implementation. This will allow
older persons to successfully utilise these
spaces to facilitate the potential health
benefits that outdoor activity can
convey,5 and without which the
associated health benefits are unlikely to
be achieved.
Conclusion
The increasing prevalence of older
persons, coupled with the World Health
Organization’s call for outdoor spaces to
be effectively utilised to deliver
population-based health interventions,
provides the platform for further
exploration of outdoor spaces as a
medium for healthcare intervention. If
designed in a way that ensures adequate
engagement and adherence, interactive
6. Lestan K, Eržen I, Golobiž M. The role of open
space in urban neighbourhoods for health-
related lifestyle. International Journal of
Environmental Research and Public Health
2014; 11: 6547–70.
7. Othman A, Fadzil F. Influence of outdoor space
to the elderly wellbeing in a typical care centre.
Procedia – Social and Behavioral Sciences
2015; 170: 320–9.
8. Yung E, Conejos S, Chan E. Social needs of the
elderly and active aging in public open spaces
in urban renewal. Cities 2016; 52: 114–22.
9. Loukaitou-Sideris A, Levy-Storms L, Chen L
et al. Parks for an aging population: Needs and
preferences of low-income seniors in Los
Angeles. Journal of the American Planning
Association 2016; 82: 236–51.
10. Lappset. Active aging. Report. Rovaniemi:
Lappset Group, 2014.
July 2017 Vol 137 No 4 l Perspectives in Public Health  213
outdoor spaces may enable older
persons to offset chronic diseases,
maintain their independence and increase
their quality of life. Outdoor interactive
spaces therefore have the potential to be
utilised as a vehicle to provide a cost
effective, community-based exercise
alternative option for older persons that
could decrease the burden on primary
healthcare infrastructure. However,
despite the potential benefits of such
outdoor spaces for older persons, there
are currently limited data to support their
appropriate design and implementation.
What is urgently required is a focused
exploration of population demographics,
human factors and design parameters to
accurately outline appropriate design
parameters and guide appropriate
development of outdoor spaces for older
persons. Furthermore, a systematic
evaluation of the age-suitability of current
outdoor exercise equipment would also
assist in guiding design parameters for
such installations. In this way, an
evidence base can be developed from
which to move forward and implement
such spaces effectively for the benefit of
older persons in our communities.
11. World Health Organization. WHO global report
on falls prevention in older age. Report, WHO,
2007.
12. Edington D, Schultz A, Pitts J et al. The future
of health promotion in the 21st century: A
focus on the working population. American
Journal of Lifestyle Medicine 2016; 10:
242–52.
13. Chow H. Outdoor fitness equipment in parks:
A qualitative study from older adults’
perceptions. BMC Public Health 2013; 13.
14. Volkanovski J, Marshall N. Seniors’
playgrounds may never get old. In State of
Australian Cities Conference, Gold Coast,
Australia, 9–11 December 2015.
15. Scott A, Stride V, Neville L et al. Design and
promotion of an outdoor gym for older adults:
A collaborative project. Health Promotion
Journal of Australia 2014; 25: 212–4.