Executive Summary: The connection between the outdoor environment and general well-being has been intuitively recognized for centuries. Recent research has built a body of knowledge supporting the role of parks and trails in public health regarding physical, mental, social and ecological health domains. However, different populations and communities use parks and trails in varying ways and to different degrees. Understanding these differences can play an important role in guiding systematic park and trail system planning for maximizing beneficial health outcomes. In light of this, a collaborative process involving the National Park Service (NPS) Rivers, Trails, and Conservation Assistance Program (RTCA) and North Carolina State University (NCSU), with support from the Centers for Disease Control and Prevention (CDC), was used to identify potential health measures associated with public parks and trails that could be used for future surveillance, advocacy, and planning. This literature review is the initial step in the process of recommending measures that are both valid and feasible for practitioner and planning use. A systematic strategy was utilized to search for studies that incorporated measures of health or well-being related to parks and trail system planning. A total of 37 study measures were identified that focused on one of five health categories: physical, psychological, social, ecosystem services, and the built environment. Current practices for allocating parks and trails in the planning process are not based on empirical evidence and may or may not support the goals of public health and well-being that were a large part of the original impetus for providing public parks and trails. The health problems agencies are trying to address are not going away, and may be exacerbated by new ones as cities continue to grow and change. The intent of this study is to identify validated metrics, which link parks and trails to public health goals. The collection of park and trail data related to these public health outcomes could be used to inform policies, practices, guidelines, and other strategies for the allocation and management of parks and trails. Results from this research have four important implications for professionals and advocates in the fields of parks, recreation, trails, greenways, open space, and health: (1) to help make the case for public health goals related to park and trail system planning; (2) guide practitioners in their efforts to provide health-related recreation opportunities; (3) support community recreation and conservation projects; and (4) encourage more productive conversations among planners, advocates, managers, and researchers.
