original research
Journal of Physical Activity and Health, 2011, 8, 741 -749
© 2011 Human Kinetics, Inc.
Distance to Green Space and Physical Activity:
A Danish National Representative Survey
Mette Toftager, Ola Ekholm, Jasper Schipperijn, Ulrika Stigsdotter, Peter Bentsen,
Morten Grønbæk, Thomas B. Randrup, and Finn Kamper-Jørgensen
Background: This study examines the relationship between distance to green space and the level of physical
activity among the population of Denmark. In addition, the relationship between distance to green space and
obesity is investigated. Methods: Data derived from the Danish National Health Interview Survey 2005, a
cross-sectional survey based on a region-stratified random nationally representative sample of 21,832 Danish
adults. All data are self-reported. Results: Respondents living more than 1 km from green space had lower
odds of using green space to exercise and keep in shape compared with persons living closer than 300 m to
green space (OR: 0.71; 95% CI: 0.60–0.83). A relationship between moderate/vigorous physical activity during
leisure time and distance to green space can also be found. Persons living more than 1 km from green space
had higher odds of being obese (BMI ≥ 30) than those living less than 300 m from green space (OR: 1.36;
95% CI: 1.08–1.71). Conclusions: Self-reported distance to green space is related to self-reported physical
activity and obesity. To exercise and keep in shape is an important reason for visiting green space, and distance
to green space is associated with moderate/vigorous physical activity in leisure time.
Keywords: built environment, exercise, overweight, public health, health survey
Regular physical activity has been shown to reduce
overall mortality and chronic diseases, such as coronary
heart disease, type 2 diabetes, high blood pressure,
and colon cancer, as well as mental ill-health.1 Due to
increasingly sedentary jobs and an increased reliance
on motorized transport, leisure time physical activity
may be important in fulfilling the recommended levels
of physical activity. Leisure time physical activity can
be conducted in a variety of community environments,
such as green space (eg, local parks, urban woodlands
and other nature areas). Parks and other green space can
be considered as health supportive environments because
they are common community features that offer a wide
range of free or low cost activities close to where people
live. The use of green space can have physical, mental,
and social health benefits: physical health benefits from
physical activity;2 mental health benefits by improving
one’s mood, reducing stress, and enhancing one’s sense of
wellness;3–6 and social health benefits such as increased
social capital.7,8 Green space can facilitate social interactions, provide meeting places where people can develop
social ties and a setting where health behavior (such as
Toftager, Ekholm, Grønbæk, and Kamper-Jørgensen are with
the National Institute of Public Health, University of Southern
Denmark, Copenhagen, Denmark. Schipperijn, Stigsdotter,
Bentsen, and Randrup are with the Dept of Forest & Landscape,
University of Copenhagen, Frederiksberg C, Denmark.
physical activity) is modeled.9 Moreover, green space can
have economic (proximity to green space is positively
related to property value10) and environmental (trees play
a role in reducing air pollution11 and moderate temperatures by providing shading and cooling12) benefits for
the community simply because of the existence of green
space.13,14 Combining the beneficial effects of physical
activity with the potentially positive effects of green
space could indicate an important role for green space in
facilitating public health.13,15
The aims of this study were to investigate the relationship between distance to green space and physical
activity in green space and moderate/vigorous physical
activity during leisure time. In addition, the relationship between distance to green space and obesity was
examined.
Methods
Data
The National Institute of Public Health, University of
Southern Denmark has carried out nationally representative health interview surveys since 1987. The purpose of
these surveys is to describe and analyze the status and
trends in health and morbidity in the adult population (16
years or older). At the same time, the survey is designed
to identify factors that influence health status, such as,
health behavior, health habits, lifestyles, environmental
and occupational health risks, and health resources. The
741
742 Toftager et al
data in the current study are derived from the Health
Interview Survey in 2005 and are based on a regionstratified random sample of 21,832 adult Danes. The
sample was drawn from the Danish Civil Registration
System (all residents in Denmark have a unique personal
registration number). All selected subjects received a
letter of introduction that briefly described the purpose
and contents of the survey and it was emphasized that
participation was voluntary. The survey was approved by
the Danish Data Protection Agency. Data were collected
via face-to-face interviews in the respondent’s home and
following the interviews, all respondents were asked to
complete a self-administered questionnaire (the questions
regarding distance to green spaces were asked in the
self-administered questionnaire). In all, 14,566 individuals (66.7%) completed a personal interview and 11,238
individuals (77.1% of those completing the face-to-face
interview) returned the self-administered questionnaire.16
Measures
Green Space. The respondents were asked about the
distance from their home to different kinds of green
space. The possible answer categories were less than
300 m, 300 m to 1 km, 1 to 5 km, and more than 5 km.
These classifications are based on earlier findings that
there is a steep decline in use frequency of recreational
facilities with increasing distance, especially over the
first 300 m.17 For distances from 1 to 5 km it is likely that
the respondents can walk or bike within 10 to 15 minutes,
for distances of more than 5 km, respondents are most
likely to use their car, or public transport. The question
was repeated for each of the following areas: beach, sea,
lake, park, urban green space, forest; agricultural fields;
and other open green space. In the current study, agricultural fields were excluded from the analyses because this
kind of green space is not suitable for recreational use
and therefore not relevant. All the other types of green
spaces were grouped into 1 variable, so that the shortest
distance to any of the green spaces included was used as
the overall measure of distance to green space. Following these questions, respondents were asked about the
most important reasons for using green space. One of the
possible answers was to exercise/keep in shape, and this
variable is used as a measure for using green space for
exercise. Other possible answer categories were to enjoy
the weather and get fresh air, to reduce stress, to relax,
to follow the seasons, or to experience flora and fauna.
Physical Activity in Leisure Time. A question regard-
ing physical activity level in leisure time during the past
year was included in the face-to-face interview with the
following categories: a) heavy exercise and competitive
sports regularly and several times a week; b) exercise
or heavy gardening at least 4 hours a week; c) walking,
biking or other light exercise at least 4 hours a week
(including Sunday excursions, light gardening and
cycling or walking to work); and d) reading, watching
TV, or other sedentary activities. Categories a) and b)
were combined to create an overall measure of moderate
or vigorous active in leisure time. The question used to
measure physical activity has shown the ability to predict
cardiovascular morbidity and mortality18 and has been
used in the National Danish Health Interview surveys for
nearly 20 years.16
Body Mass Index. Self-reported height and weight in
the face-to-face interview were used to calculate Body
Mass Index (BMI) (weight in kg/height in m2). A BMI
index of 25 or more is the threshold for being overweight
and 30 is the threshold for being obese.19
Potential Confounding Factors. Other variables
included in the study were: educational level, accommodation type, size of municipality, marital status,
self-reported long-term activity limitation, sex, and age.
Educational level was classified according to the International Standard Classification of Education (ISCED),
which combines school and vocational education, and
can be seen as a proxy for socioeconomic status. An
educational level less than 10 years is considered to
be low and educational level more than 13 years is
considered to be high. The interviewer registered type
of accommodation at the time of the face-to-face interview. The population sizes of the Danish municipalities
were obtained from Statistics Denmark. Self-reported
long-term activity limitations were used as a measure of
disability and were assessed by 2 questions. The initial
question was, ‘During the past 2 weeks, has any disease,
disorder, illness, or injury made it difficult or impossible
for you to carry out your usual daily activities? (Such
as work outside the home or domestic work or leisure
activities).’ The response categories were ‘yes’ and ‘no.’
People who had responded positively to this question
were subsequently asked: ‘Have these difficulties or
limitations been long term? Long term here means that
the difficulties or limitations have lasted or are expected
to last 6 months or more.’ Again, the response categories
were ‘yes’ and ‘no.’ Persons who had responded positively to the latter question were considered to have a
long-term activity limitation.
Statistical Analysis
Multiple logistic regression analyses were used to investigate the relationship between distance to green space
and physical activity. Multiple logistic regression analyses were also used to examine the relationship between
distance to green space and BMI, and the analyses were
adjusted for potential confounding factors. The results are
presented as percentage and odds ratios (OR) with 95%
confidence intervals (CI). Goodness of fit of the models
was assessed by the Hosmer-Lemeshow Test20 and the
tests indicated that the models fit the data adequately.
Distance to Green Space and PA 743
All estimates presented in this study were weighted to
take into account the complex sampling design of the
survey. Statistical analyses were performed using SAS
version 9.1.
Results
Table 1 shows demographic characteristics of respondents
according to distance to green space. In all, 12.9% of
respondents living less than 300 m from green space had
less than 10 years of education compared with 20.5% of
respondents living more than 1 km from green space.
Furthermore, 18.7% of respondents living less than 300
m from green space lived in an apartment compared
with 29.1% of respondents living more than 1 km from
green space. Furthermore, differences can be seen in
marital status, and size of municipality. There seems to
be no significant differences in smoking, and alcohol
consumption according to distance to green space, but
people living more than 1 km from a green space reported
a lower daily fruit intake compared with those living in
closer proximity (Table 1).
A higher proportion of men reported that they did
moderate (27.9%) or vigorous (5.4%) physical activity during leisure time compared with that reported by
women (19.5% and 2.3%, respectively). Overall, 27.1%
of the respondents reported being moderately (23.4%)
or vigorously (3.7%) physical active in leisure time. In
all, 43.8% of the respondents were overweight (BMI ≥
25) and 11.0% were obese (BMI ≥ 30). More than twothirds (66.9%) of the respondents reported living less
than 300 m from green space (Table 2). More than half
of the Danish population (54.7%; not shown in table)
reported that the most important reason for using green
space was to exercise/keep in shape. There was a higher
prevalence of women reporting this compared with men
(57.8% vs. 51.1%) (Table 3).
Table 3 shows that living close to green space was
related to physical activity in green space. Respondents
living more than 1 km from a green space were less likely
to report that the most important reason for using green
space was to exercise/keep in shape compared with those
living closer than 300 m from a green space (OR: 0.71;
95% CI: 0.60–0.83). Elderly persons were more likely
to report that the most important reason for using green
space was to exercise/keep in shape than were younger
persons; persons with more education were more likely
to report that the most important reason for using green
space were to exercise/keep compared with those with
less education. Persons without a long-term activity limitation were more likely to report that the most important
reason for using green space was to exercise/keep than
those with a long-term activity limitation. Respondents
living in a detached house were more likely to report that
the most important reason for using green space was to
exercise/keep than respondents living in an apartment,
farm or other type of household (Table 3).
Table 4 shows the association between distance to
green space and level of physical activity in leisure time,
adjusted for potential confounders. The results indicate
that living close to green space is related to moderate
or vigorous physical activity during leisure time. For
example, respondents living 300 m–1 km from green
space were less likely to conduct moderate or vigorous
physical activity than those living closer than 300 m from
a green space (OR: 0.88; 95% CI: 0.79–0.98) (Table
4). Furthermore, Table 4 shows that respondents living
more than 1 km (We note that this is only 6.2%) from a
green space had a higher odds of being obese (BMI ≥ 30)
than did respondents living closer than 300 m to a green
space (OR: 1.36; 95% CI: 1.08–1.71), when adjusted for
potential confounders.
Table 5 shows the relationship between the distributions of respondents on the 2 central variables: ‘physical
activity in green space’ and ‘moderate/vigorous physical
Table 1 Study Characteristics According to Distance to Green Space (%)
Sex (% men)
Mean age (years)
Marital status (% married)
Combined school and vocational education (% <10 y)
Accommodation type (% living in apartment buildings)
Size of municipality (% ≥100,000 inhabitants)
Smoking status (% daily smokers)
Alcohol consumption (% high alcohol intakea)
Fruit intake (% daily intake)
Number of respondents
a Men:
>21 drinks/week; Women >14 drinks/week.
<300 m
46.9
48.7
59.5
12.9
18.7
18.9
26.8
14.4
53.1
7546
300 m–1 km
45.5
48.3
54.9
12.4
29.2
25.8
27.2
15.3
53.6
2866
>1 km
43.5
51.2
48.9
20.5
29.1
24.8
28.6
13.6
48.4
680
Total
46.3
48.9
57.6
13.2
22.2
21.1
27.0
14.6
53.0
11,092
744 Toftager et al
Table 2 Distribution of Respondents on Central Variables (%)
Men
Women
Total
Vigorous
Moderate
Light
Sedentary
Total
Number of respondents
Body Mass Index (BMI)*
5.4
27.9
55.1
11.1
100.0
5196
2.3
19.5
67.7
10.5
100.0
6023
3.7
23.4
61.9
10.6
100.0
11,219
<18.5 (underweight)
18.5–<25 (normal weight)
25–<30 (overweight)
≥30 (obese)
Total
Number of respondents
Distance to green space
0.7
46.6
41.2
11.6
100.0
5202
3.3
60.6
25.6
10.5
100.0
6014
2.1
54.1
32.8
11.0
100.0
11,216
67.8
26.4
5.7
0.1
100.0
5158
66.2
27.4
6.2
0.3
100.0
5934
66.9
26.9
6.0
0.2
100.0
11,092
Physical activity in leisure time*
<300 m
300 m–1 km
1–5 km
>5 km
Total
Number of respondents
* Sex: P < .05.
activity in leisure time.’ Only 33.7% of respondents who
reported that the most important reason for using green
space was to exercise/keep in shape were also moderately
or vigorously physically active during leisure time.
Discussion
This study is the first to examine how distance to green
space is related to physical activity in a large, Danish,
nationally representative sample. The distance to green
space seems to predict whether respondents use green
space for exercise. We found that living close to green
space is associated with moderate or vigorous physical
activity in leisure time, even after controlling for potential confounders. The evidence regarding this finding is
contradictory. Some studies support this hypothesis,21–26
while other studies have not found such a relation.27,28 In
the 2 latter studies the distance to green space was measured objectively using Geographic Information System
(GIS). In the current study, the respondents’ self-reported
distance to green space is used. It has been argued that
respondents’ perception of distance and access to recreational facilities is a better predictor of physical activity
than objectively measured distance.29 The explanation
is probably due to an increased awareness of distance or
travel time among those who actively use green space
or other recreational facilities. Due to the large sample
size, we suspect that potential over- or under-estimation
of distances to the nearest green space will have evened
out. In the current study, it was not possible to measure
specific features in the different kinds of green spaces, but
there is no doubt that physical condition, access, aesthetics, and perception of safety play an important role in the
use of green space for exercise purposes.
In our study, women and elderly persons used green
space for exercise more often than did men and younger
persons. This is in contrast to another study based on
the same data that showed men and young people were
generally more moderately or vigorously physically
active during leisure time.30 A possible explanation for
this difference is that women and older people generally practice more ‘light’ exercise such as walking and
biking, activities that are very common in green spaces.
This is supported by our findings that only one-third of
respondents who were physically active in green space
were also moderately or vigorously physically active in
their leisure time (Table 5). This indicates that much of
the physical activity taking place in green space is within
the category of ‘light exercise.’ Respondents living more
than 1 km away from green space were found to have
higher odds of being obese compared with those living
less than 300 m from green space, after controlling for
potential confounders. Few studies have examined this
relationship. A Swedish study found comparable results.31
Similarly, an American study21 concluded that a high
Distance to Green Space and PA 745
Table 3 Results From a Multiple Logistic Regression Analysis Showing the Association Between
Potential Predictors (Including Distance to Green Space) and Exercise/Keep in Shape as Most
Important Reason for Visiting Green Space
%
OR
95% CI
n
<300 m
55.9
1.00
300 m–1 km
>1 km
Sex*
54.5
46.3
0.95
0.71
(0.87–1.04)
(0.60–0.83)
2834
673
Men
Women
51.1
57.8
0.75
1.00
(0.69–0.81)
5145
5933
16–24 y
25–44 y
45–64 y
57.9
51.2
55.1
1.13
0.80
1.00
(0.94–1.35)
(0.73–0.88)
956
3611
4294
65+ y
Combined school and vocational education*
58.5
1.37
(1.22–1.54)
2217
<10 y
10–12 y
49.4
49.2
58.2
0.60
0.65
1.00
(0.53–0.69)
(0.59–0.72)
1520
3003
6248
Married
56.3
1.00
Cohabiting
Single (divorced, separated, widowed)
Single (unmarried)
Accommodation type*
49.1
54.0
55.0
0.85
0.89
1.04
(0.75–0.95)
(0.78–1.01)
(0.91–1.20)
1657
1315
1604
Apartment building
A single-, 2-, 3-, or 4-family house, linked courtyard
or townhouse
Farm
Other (eg, institution)
Size of municipality*
50.7
0.81
(0.73–0.90)
2061
57.1
46.9
46.5
1.00
0.68
0.65
(0.58–0.79)
(0.49–0.88)
7817
932
204
<10,000 inhabitants
51.6
1.00
10,000–<20,000 inhabitants
20,000–<40,000 inhabitants
40,000–<100,000 inhabitants
56.2
57.3
55.6
52.6
1.17
1.19
1.12
1.03
No
55.2
1.00
Yes
46.8
0.73
Distance to green space*
7474
Age*
≥13 y
Marital status*
≥100,000 inhabitants
Long-term activity limitation
6498
2094
(1.03–1.33)
(1.04–1.36)
(0.99–1.28)
(0.90–1.19)
2537
2038
2217
2192
10,384
(0.62–0.86)
694
*P < .05 in multiple logistic regression analysis.
degree of urban sprawl and low walkability (eg, very few
or no green spaces in the surroundings) in a community is
associated with obesity among residents. Another Danish
study17 found a significant negative association between
obesity and access to a private garden and the distance to
the nearest green space for respondents younger than 25
years only. On the other hand, a New Zealand national
study found that neighborhood access to parks was not
associated with BMI.32
It is unclear to what extent the association between
the level of physical activity, BMI, and distance to
green space is a function of self-selection bias.33–35 Do
746 Toftager et al
Table 4 Results From a Multiple Logistic Regression Analysis Showing the Association Between
Distance to Green Space and Moderate/Vigorous Physical Activity in Leisure Time, and Obesity
(BMI ≥ 30)
Moderate/vigorous physical activity
in leisure time
Number of
%
OR
95% CI
respondents
Obesity BMI ≥ 30
%
OR
7501
10.8
1
2849
675
10.7
14.7
1.01
1.36
95% CI
Number of
respondents
Distance to green space*
<300 m
28.3
1
300 m–1 km
>1 km
26.1
22.6
0.88
0.85
(0.79–0.98)
(0.70–1.04)
7529
(0.88–1.17)
(1.08–1.71)
2865
676
*P < .05 in both models.
Note. Adjusted for sex, age, combined school and vocational education, accommodation type, size of municipality, and long-term activity limitation.
Table 5 The Prevalence of Moderate/Vigorous Physical Activity
in Leisure Time by Exercise/Keep in Shape as Most Important
Reason for Visiting Green Space (%)
Physical activity in green space
Yes
No
Total
33.7
66.3
100
6067
19.7
80.3
100
4945
27.4
72.6
100
11,012
Moderate/vigorous physical activity in leisure time
Yes
No
Total
Number of respondents
communities with many attractive green spaces attract
people to adopt a physically active lifestyle, or is there
evidence that communities can succeed in promoting
increased physical activity among persons who are
sedentary? Although a myriad of factors influence the
communities in which people choose to live, those who
seek communities with activity-friendly characteristics
may value physical activity and health more than do
those who live in communities that do not have the
characteristics typically found in an active community
setting. As a result, people who value physical activity
may be more likely to be influenced by the types of policy
and infrastructure changes that support activity-friendly
communities. Conversely, those with less positive beliefs
about physical activity may be less influenced by infrastructure changes. However, it is impossible to control
for self-selection bias in a cross-sectional study design.
In considering evidence of causality, longitudinal studies using time-series data, case-control cross-sectional
studies, and other natural experiments may be helpful.
There is a growing body of research on neighborhood
self-selection discussing this issue.36–39
This study is based on self-reported data, and there is
a risk of respondents overestimating their level of physical
activity because exercise is known to be a healthy and
socially desirable behavior. This should, however, not be
of major concern in this study; since we have no reason
to assume that overestimation of physical activity level
depends on the distance to green space. To overcome
such potential bias, objective measures of the physical
activity level and observational studies of green space
use may be helpful.
The question used to measure physical activity
has shown the ability to predict cardiovascular morbidity and mortality18 and has been used in the National
Danish Health Interview surveys for nearly 20 years.30
Self-reported height and weight are considered valid for
identifying associations in epidemiological studies.40 The
questions concerning green spaces have previously been
used in a similar form in another Danish survey from 2003
on access to and use of green areas (1,196 respondents).17
A possible limitation of the current study is the
relatively high nonresponse rate for the self-administered
questionnaire and, hence, nonresponse analyses were
carried out. The analyses showed that the nonresponse
rate was somewhat higher for men than for women. The
nonresponse rate was particularly high among young
men and among elderly persons. As information regarding sex and age was available for all the individuals in
the sample, it was possible to carry out a nonresponse
Distance to Green Space and PA 747
adjustment (direct sex- and age-standardization by using
the sex and age distribution of the original sample as
standard). The analyses showed that the sex- and ageadjusted prevalence for the 2 indicators obesity and
vigorous or moderate physical activity during leisure
time was 11.3% and 26.8%, respectively. The unadjusted
prevalence among the respondents in the current study
was 11.0% and 27.1%, respectively. In an additional
effort to estimate the effects of nonresponse on the
estimates in the current study, some relevant indicators
(combined school and vocational education, long-term
activity limitation, moderate/vigorous physical activity
in leisure time and obesity) from the personal interview
questionnaire were selected to compare the individuals
who completed the self-administered questionnaire with
those who did not complete it. The analyses showed that
the prevalence was, overall, very similar in the 2 groups
and that the small differences seem not to substantially
alter the total prevalence (data not shown). However,
the prevalence of individuals with a high education was
somewhat lower among subjects who did not complete
the self-administered questionnaire. Altogether, there is
no indication that nonresponse has seriously biased the
results of this study.
This study supports the approach that there is a
need to change the built environment and to create more
environments supportive of ‘active living,’ indicating that
the built environment provides opportunities and barriers
for physical activity interventions. To date, efforts to promote physical activity and behavior change have largely
focused on providing information and on intervening at
the individual level. However, information-based interventions alone have not been effective in changing the
level of physical activity in the population, and scientists,
city planners, politicians, and public health workers,
among others, are increasingly realizing the need for a
change. Interventions at the environmental level may have
the potential to make a long and lasting change, to reach
a higher proportion of the population, and to reach more
sedentary groups in society.16,25,34,41–48
Future Research
Green spaces are common community features that provide opportunities for physical activity, but little is known
about the specific characteristics that are most related to
physical activity; therefore, an important next step could
be to identify the specific modifiable aspects of green
space and the built environment that are most strongly
related to physical activity. More (qualitative) research
is needed to explain why women and elderly persons
in particular find green space attractive for exercising,
and longitudinal studies are needed to determine causal
relationships. Finally, further research on green space
in relation to physical activity could include objective
measures of green space, distance, physical activity and
BMI in smaller samples, as well as an economic valuation
of green spaces in relation to public health care budgets.
Conclusion
Self-reported distance to green space is related to selfreported physical activity and obesity. To exercise and
keep in shape is an important reason for visiting green
space, and distance to green space is associated with
moderate/vigorous physical activity in leisure time. Green
space is an important setting for physical activity, and
access to green space close to people’s homes should be
included in public health strategies to promote physical
activity. Proximity to green space in the neighborhood is
associated with the use of green space for exercise and
general moderate or vigorous physical activity during
leisure time. Proximity to green space is, moreover,
related to a lower risk of being obese.
The results indicate the importance of planning
green space and neighborhood environments that support
active living. Green spaces, such as public parks, are a
convenient, low cost resource which enables physical
activity among residents.
Acknowledgments
Funding was received from TrygFonden and The Danish Outdoor Council.
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