A Cost-Benefit Analysis of Physical Activity Using Bike/Pedestrian Trails

Abstract

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 209.28 U.S. dollars (59.28 U.S. dollars construction and maintenance, 150 U.S. dollars of equipment and travel). Per capita annual direct medical benefit of using the trails was 564.41 U.S. dollars. The cost-benefit ratio was 2.94, which means that every 1 U.S. dollar investment in trails for physical activity led to 2.94 U.S. dollars 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 U.S. dollar investment in trails resulted in a greater return in direct medical benefit.

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Health Promotion Practice
DOI: 10.1177/1524839903260687
2005; 6; 174 Health Promot Pract
Guijing Wang, Caroline A. Macera, Barbara Scudder-Soucie, Tom Schmid, Michael Pratt and David Buchner
A Cost-Benefit Analysis of Physical Activity Using Bike/Pedestrian Trails
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ARTICLE62April HEALTH PROMOTION PRACTICE / April 2005
A Cost-Benefit Analysis of Physical
Activity Using Bike/Pedestrian Trails
Guijing Wang, PhD
Caroline A. Macera, PhD
Barbara Scudder-Soucie, MEd
Tom Schmid, PhD
Michael Pratt, MD, MPH
David Buchner, MD, MPH
From a public health perspective, a cost-benefit analy-
sis 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 indi-
cated 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.
Keywords: environment; community; inactivity; economic
analysis
I
nactivity as an independent risk factor for many
chronic diseases, such as coronary heart disease,
obesity, diabetes, hypertension, some cancers, and
some mental disorders, has been investigated by many
researchers and summarized in the surgeon general’s
report on physical activity and health (Brown, Mishra,
Lee, & Bauman, 2000; Hassmen, Kiovula, & Uutela,
2000; Martinez et al., 1997; U.S. Department of Health
and Human Services [USDHHS], 1996). The economic
burden of physical inactivity has also been demon-
strated by several researchers (Colditz, 1999; Jones &
Eaton, 1994; Keeler, Manning, Newhouse, Sloss, &
Wasserman, 1989; Nicholl, Coleman, & Brazier, 1994;
Pratt, Macera, & Wang, 2000). One study estimated that
in 1994 U.S.$5.6 billion could be saved from the cost of
coronary heart disease alone if 10% of adults began a
regular walking program (Jones & Eaton, 1994). Another
study estimated that direct medical cost associated with
physical inactivity could be as high as $76.6 billion in
1987 (in year 2000 dollars) (Pratt et al., 2000). Despite
the importance of physical activity in reducing health
costs and morbidity and mortality from chronic dis-
eases, in the past decade, the prevalence of physical
inactivity remained around 30% for adults, and the
prevalence of achieving the recommended levels of
physical activity for health benefits remained around
25% (Centers for Disease Control and Prevention [CDC],
2001).
Because of the health and economic burden of physi-
cal inactivity, promoting physical activity has become a
public health priority. Studies have shown that lifestyle
interventions are as effective as structured interven-
tions in increasing physical activity (Dunn et al., 1999).
For activities such as walking and cycling, availability
of sidewalks and bike/pedestrian trails may be an
important element needed to incorporate physical
activity into everyday life. Indeed, lack of accessible
facilities has been identified as a deterrent to a physi-
cally active lifestyle (Brownson et al., 2000; Corti, Don-
ovan, & Holman, 1997; King, 1991; King et al., 1995,
King et al., 1992; Linenger, Chesson, & Nice, 1991;
Sallis, Bauman, & Pratt, 1998; Sallis et al., 1990; Sallis,
Johnson, Calfas, Caparosa, & Nichols, 1997). It is dem-
onstrated that environments influence physical activity
behaviors (Craig, Brownson, Craag, & Dunn, 2002;
Owen, Leslie, Salmon, & Fotheringham, 2000).
Although a physical activity–friendly environment is
considered an essential component of community pro
-
motion efforts (Berrigan, & Troiano, 2002; Handy,
Boarnet, Ewing, & Killingsworth, 2002), physical envi
-
ronments are the least-studied category of influence on
physical activity, and research on the cost benefit of
174
Health Promotion Practice
April 2005 Vol. 6, No. 2, 174-179
DOI: 10.1177/1524839903260687
©2005 Society for Public Health Education
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environmental and policy interventions (such as trails)
is lacking (Sallis et al., 1998).
Several cost-benefit and cost-effectiveness studies of
physical activity programs have been published
(Hatziandreu, Koplan, Weistein, Caspersen, & Warner,
1988; Jones & Eaton, 1994; Lowensteyn, Coupal,
Zowall, & Grover, 2000; Robertson, Devlin, Gardner, &
Campbell, 2001; Robertson et al., 2001; Sevick et al.,
2000), yet none has examined the economics of envi-
ronmental facilities, such as bike/pedestrian trails. A
study suggested that construction of walking trails may
be a viable intervention strategy for physical activity
intervention (Brownson et al., 2000) but did not provide
any economic justification of such an intervention. In
the current study, a cost-benefit analysis of physical
activity through constructing and maintaining bike/
pedestrian trails in Lincoln, Nebraska, was conducted.
>
DATA AND METHODS
Construction and Maintenance of Trails
Construction and maintenance costs are usually
incurred to the community, local government, or other
organizations. The cost of construction and annual
maintenance costs of five bike/pedestrian trails in Lin-
coln, Nebraska, was obtained from a census report (Lin-
coln Recreational Trails Census Report, 1998) and per-
sonal communications with Lincoln’s Department of
Parks and Recreation. In addition to the cost informa-
tion, the investigators also identified the information
about surface types, date built, and length of each trail.
It is assumed that the trails could be used for an average
of 30 years, and the construction costs were allocated
evenly over that period. The annual total trail cost (con-
struction and maintenance) was adjusted to 1998
dollars.
Trail Use and Trail Cost per Use
The number of users for a day (July 12, 1998) on each
of the five trails was obtained from the census report
(Lincoln Recreational Trails Census Report, 1998). The
census began at 7:00 a.m. and concluded at 9:00 p.m.
that evening. The census volunteers, who worked 2-hr
shifts, counted cyclists, runners, walkers, skaters, and
miscellaneous users (such as persons with skateboards,
wheelchairs, horses, etc.). Because the census was con-
ducted on a Sunday in summer, the number of users
may be improper for the analysis. To determine if the
number of users from the census was acceptable, the
investigators looked at the number of users across a
week and found that the number of users was the lowest
on Saturdays and Sundays and the highest on Wednes-
days and Thursdays. In fact, the number of users on
Wednesday might be more than twice as high as the
number on Sundays in Missouri (a state adjacent to
Nebraska; personal communication). Based on this
information and Nebraska climate (3 to 4 months of
winter), it was believed that the number of users
reported in the census was acceptable for the analysis.
This number was multiplied by 365 days to derive the
number of uses of each trail during a year. The trail cost
per use was calculated by dividing annual total trail
cost by the number of trail uses per year.
Equipment and Travel
Trail users needed to buy some equipment to use the
trail for physical activity and had to travel to and from
the trails. Such expenses are usually borne by the trail
users, which were estimated at $100 per year in 1988
(Hatziandreu et al., 1988). This figure was inflated to
$150 in 1998. Ideally, the indirect cost of physical activ-
ity, such as the monetary value of time spent doing
physical activity, should be assessed because time is
one of the most often cited reasons for being physically
inactive (Sallis et al., 1990). However, it is assumed that
the majority of trail use was during leisure time. In addi-
tion, the current study included only direct medical
cost saving as the benefits and did not assess the benefit
to psychological well-being from physical activity.
Therefore, no indirect cost, such as time value, was
assessed for the current study.
Direct Health Benefit
The direct health benefit was measured using the
estimated difference in the direct medical cost for active
persons and their inactive counterparts (excluding per
-
sons with physical limitations). The medical cost may
be paid out of pocket, through insurance policies, or by
government programs. A study using a nationally repre
-
Wang et al. / COST-BENEFIT ANALYSIS OF PHYSICAL ACTIVITY 175
The Authors
Guijing Wang, PhD, is an economist at the Centers for Dis-
ease Control and Prevention in Atlanta, Georgia.
Caroline A. Macera, PhD, is a senior epidemiologist at the
Centers for Disease Control and Prevention in Atlanta,
Georgia.
Barbara Scudder-Soucie, MEd, is a health promotion spe-
cialist in the Physical Activities Program at the Nebraska
Health and Human Services System in Lincoln.
Tom Schmid, PhD, is coordinator of the Active Community
Environments (ACES) Workgroup at the Centers for Disease
Control and Prevention in Atlanta, Georgia.
Michael Pratt, MD, MPH, is medical officer at the Centers
for Disease Control and Prevention in Atlanta, Georgia.
David Buchner, MD, MPH, is chief of the Physical Activity
and Health Branch, Division of Nutrition and Physical
Activity, National Centers for Chronic Disease Prevention
and Health Promotion, Centers for Disease Control and Pre
-
vention in Atlanta, Georgia.
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sentative National Medical Expenditure Survey found
that, on average, active persons spent $330 (95% CI:
$214 to $446) less on medical care than did inactive per-
sons in 1987. Adjusted to 1998 dollars, this figure is
$564 (95% CI: $365 to $763) (Pratt et al., 2000).
In the National Medical Expenditure Survey, moder-
ate physical activity was defined as spending at least 30
min in moderate or strenuous physical activity three or
more times per week. It is assumed that all trail users
met this criterion if they used the trails three or more
times per week.
Cost-Benefit Ratios
A cost-benefit ratio was derived by dividing the
direct medical cost saving by the total trail costs (con-
struction, maintenance, equipment, and travel). The
cost-benefit ratio shows how much health benefit can
be achieved from a $1 investment in using a trail. If the
ratio is larger than one, then using a trail is cost-benefi-
cial. Otherwise, the return is less than the investment.
Sensitivity Analyses
Sensitivity analyses were conducted by worst- and
best-case scenarios for several key parameters. For the
costs of constructing and maintaining of the five trails
included in the census report, the most and least expen-
sive trails were used. Equipment and travel costs were
ranged from $0 to $300 ($150 below or above the
assumed average), the upper and lower bounds of the
95% CI of the direct health benefit were used, the life of
trails was varied from the assumed average by 20 years,
and the number of trail uses was varied by 50% from the
actual number.
>
RESULTS
Among the five trails, the average construction cost
per trail was $1.35 million (range: $0.95 million to $2.74
million). Allocated over a 30-year period, the average
annual construction cost per trail was $44,949 (range:
$3,184 to $91,334). Annual maintenance cost averaged
$15,445 (range: $7,040 to $26,183). Together, the annual
construction and maintenance costs averaged $60,494
per trail (range: $18,164 to $117,517) (Table 1).
During 1998, the trails were used an average of
225,351 person times (range: 58,035 to 597,870) (see
Table 1). Average trail cost per use was $0.27 (range:
$0.20 to $0.78).
The annual trail cost for a person to use a trail for 52
weeks, 3 times per week, and $0.27 each time is
52 × 3 × $0.27 = $42.12. Then adding $150 for equip-
ment and travel, the total annual cost per trail user rose
to $42.12 + $150 = $192.12. The annual direct health
benefit of using the trail was $564.41 in 1998. Thus, the
cost-benefit ratio was $564.41/$192.12 = 2.94, which
means that every $1 investment in using trails led to
$2.94 in direct medical benefit.
In all the sensitivity analyses, the cost-benefit ratio
was larger than one (see Table 2). Even in the most sen-
sitive worst-case scenario (high equipment cost), the
direct medical benefit outweighed the cost by more
than 65%.
>
DISCUSSION
The current study is the first, as far as we know, to
report the economics of bike/pedestrian trails from a
public health perspective. It is noticed that trail cost
varied according to the surface type and length of the
176 HEALTH PROMOTION PRACTICE / April 2005
TABLE 1
Total Annual Trail Cost ($), Annual Number of Trail Users, and Trail Cost per Use in 1998
Annual Trail Cost
Construction Maintenance Total Annual No. of
Total Lincoln Construction +
Trail Uses
Trail Cost
Construction Recreational Maintenance No. of Uses
per Use
Cost Trails per day
(Lincoln Census (Lincoln Total
Recreational Report Recreational Annual
Trails Trails Trail Cost /
Census Census Annual
Report)/ Report) no. of
Data Source 30 Years 365 days Trail Uses
Trails:
Concrete, 2 bridges, 4.6 miles 91,334 26,183 117,517 597,870 0.20
Limestone chip, 0 bridges, 4.5 miles 3,184 14,980 18,164 84,680 0.21
Concrete, 3 bridges, 4.1 miles 59,608 11,828 71,436 299,300 0.24
Concrete, 0 bridges, 3.1 miles 50,656 17,196 67,852 86,870 0.78
Concrete, 1 bridge, 1.6 miles 19,962 7,040 27,002 58,035 0.47
Average 44,949 15,445 60,394 225,351 0.27
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trail. The least expensive of the five trails had a lime-
stone chip surface with no bridges, and the most expen-
sive trail had a concrete surface with two bridges. The
wide variation in expenses makes building trails feasi-
ble across various communities (high-income or low-
income, rural or urban areas). Local communities can
build different types of trails according to their budget
constraints.
The average trail cost per use, including construction
and maintenance costs, was only $0.27. Even the most
expensive trail was only $0.78 per use. This is substan-
tially lower than most admission fees to health club
facilities with exercise equipment, running tracks, and
swimming pools. The number of uses rose with the
length and quality of trails (surface type and number of
bridges). This observation suggests that longer and more
expensive trails may be more economically sound if
more people use them, although other features may also
stimulate people’s interest in using trails (e.g., location,
safety, and accessibility).
Of the total cost of using trails per person, less than
22% ($42 of $192) were building and maintaining
expenses. Therefore, the major part of the cost was the
cost of equipment and traveling to and from the trails.
Furthermore, the cost-benefit ratio was most sensitive
to the equipment and travel costs. Because these costs
are an important factor affecting the use of trails and
because trail users pay these costs out of their own
pockets, enhancing awareness of the health benefits of
physical activity among residents should be an impor-
tant component in public health intervention programs.
The cost-benefit ratio appeared not sensitive to the
total annual trail cost and the number of years the trail
could be used. Even for the most expensive trail and the
shortest life period, a $1 investment resulted in about a
$2 return. This finding indicates that as long as a trail
can be used for 10 years or more, the benefit
will outweigh the investment.
The estimates of cost-benefit ratios are con-
servative because only direct medical benefits
among people without physical limitations
were included; however, all trail costs (con-
struction, maintenance, equipment, and
travel) were included. Physical activity will
also yield indirect benefits to trail users, such
as increased quality of life and psychological
well-being. In fact, the current trails were
built as part of the community development
planning. The main purpose of building these
trails was not for health promotion or reduc-
tion of health care costs. Therefore, the health
benefit used for the analysis was a component
of the trail benefits. In addition, if the national
sample for the analysis of medical costs
included people with physical limitations,
the direct health benefit should be even big-
ger, which is in favor of a larger cost-benefit
ratio.
Several limitations should be mentioned. First, the
trail cost and use information were based on five trails.
The sample is too small to furnish a vigorous quantita-
tive analysis, so the representativeness of the cost and
use data is limited. The cost of construction and mainte-
nance of trails is believed to vary greatly across commu-
nities. In addition, certain trail information (e.g., qual-
ity of maintenance, appropriateness of joint use by
walkers and cyclists, and design of pedestrian cross-
ings) is lacking. The second limitation is that although
the direct medical benefit is from a nationally represen-
tative sample, the definition of physical activity may
not be comparable with the physical activity level
obtained by using trails. Using the trails three times a
week was used as a measure of moderate physical activ-
ity, which may not be comparable with the physical
activity measure in the National Medical Expenditure
Survey. Furthermore, the direct medical benefit was
derived from a national sample of people 15 years of age
or older; no information on the age of the trail users was
available. Finally, findings of this research should be
interpreted as estimates under the assumption that peo-
ple were using trails for the health benefits of physical
activity. Because there is a lack of information about
changes in physical activity behavior of the trail users,
the impact of trails on health promotion cannot be eval-
uated using more advanced models such as
transtheoretical models (Mettler, Stone, Herrick, &
Klein, 2000). Therefore, the cost-effectiveness of the
trails in promoting physical activity cannot be claimed.
Future research should focus on comprehensive data
collection efforts. In addition to the cost information
presented in the current study, behavioral and health
information of trail users are needed for conducting
comprehensive cost-effectiveness studies. These stud
-
ies will certainly aid policy makers in making informed
Wang et al. / COST-BENEFIT ANALYSIS OF PHYSICAL ACTIVITY 177
TABLE 2
Cost-Benefit Ratios of Extreme Cases of Physical Activity
Using Bike/Pedestrian Trails in 1998 (U.S. dollars)
Worst-Case Scenarios Best-Case Scenarios
Cost-Benefit Cost-Benefit
Variable Value Ratio Value Ratio
Cost of trail
construction
and
maintenance $0.78/use 2.08 $0.20/use 3.12
Equipment and
travel cost $300/year 1.65 $0/year 13.40
Direct health
benefit $365/year 1.90 $763/year 3.97
Life of trail 10 years 2.22 50 years 3.14
Number of
trail users 50% below 50% above
actual number 3.39 actual number 3.63
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decisions in resource allocations. Clearly, more data
and other methods are needed in this regard.
Several strengths of the current study should also be
mentioned. First, actual construction and maintenance
cost data for five trails were used. The five trails vary in
surface types, length, and number of bridges. Although
the results may not be generalized to the nation, the
variety of the trails covered in the current study should
enhance the generality at the local community level.
Second, all the direct costs and direct benefits were con-
verted to a per capita basis. Therefore, the costs and ben-
efits were comparable and an economic measure cost-
benefit ratio could be derived. Finally, sensitivity anal-
yses for all the five key parameters were conducted. The
ranges of the parameters may be wide enough to cover
all the possible situations.
>
CONCLUSIONS AND PUBLIC
HEALTH IMPLICATIONS
To promote physical activity at population level
presents a public health challenge. Building environ-
ments that are more favorable to physical activity
should facilitate the promotion. In fact, interventions
that attempt to change the environments to create
opportunities for physical activity have been strongly
recommended (Task Force on Community Preventive
Services, 2002). However, a potential barrier of creating
the opportunities is that building such environments is
resource intensive (Kahn et al., 2002). The current study
demonstrated that building bike/pedestrian trails might
fit a wide range of budget situations facing
communities.
The cost-benefit information presented in the current
study provides evidence that building bike/pedestrian
trails may be cost-beneficial. The resource expenses on
using the trails may be outweighed by the direct health
benefits alone. Moreover, the results show that the con-
struction and maintenance costs per use are low, and
the direct medical benefit of using trails is nearly three
times as high as the direct cost. Building trails may be a
cost-effective means for physical activity promotion at
the community level. This information should be useful
to policy makers and community organizations for deci-
sions in implementing such interventions.
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