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Neighborhood parks are important venues to support moderate-to-vigorous (MVPA) activity. There has been a noticeable increase promoting physical activity among youth in neighborhood parks. This paper aims to assess the association between park use and MVPA among low-income youth in a large urban area. We recruited a cohort of 434 youth participants during the COVID pandemic years (2020–2022) from low-income households in Washington, D.C. We collected multiple data components: accelerometry, survey, and electronic health record data. We explored the bivariate relationship between the accelerometer-measured daily MVPA time outcome and survey-based park use measures. A mixed-effect model was fitted to adjust the effect estimate for participant-level and time-varying confounders. The overall average daily MVPA time is 16.0 min (SD = 12.7). The unadjusted bivariate relation between daily MVPA time and frequency of park visit is 1.3 min of daily MVPA time per one day with park visits (p < 0.0001). The model-adjusted estimate is 0.7 daily MVPA minutes for 1 day with park visit (p = 0.04). The duration of a typical park visit is not a significant predictor to daily MVPA time with or without adjustments. The initial COVID outbreak in 2020 resulted in a significant decline in daily MVPA time (− 4.7 min for 2020 versus 2022, p < 0.0001). Park visit frequency is a significant predictor to low-income youth's daily MVPA time with considerable absolute effect sizes compared with other barriers and facilitators. Promoting more frequent park use may be a useful means to improve low-income youth's MVPA outcome. [ABSTRACT FROM AUTHOR]

The Park Rx study is a prospective, randomized controlled trial implemented within a federally qualified health center serving a low-income population in Washington, DC. The 5-year randomized controlled trial will recruit 500 children, ages 6–16 to be randomized to receive either a park prescription (Park Rx) during routine clinical visits (intervention arm) or care as usual (control arm). Park prescriptions promote both physical activity and exposure to nature. The prescription includes a place (i.e., park), an activity, a frequency, and a duration. Compared to usual care, we expect children receiving a park prescription will have greater physical activity levels and improved physical and mental health outcomes. The results of the Park Rx trial will demonstrate the efficacy of the intervention and whether it will increase time spent in nature-rich areas (i.e., parks); have any biological impacts on health, including reducing hypercholesterolemia, hypertriglyceridemia, HbA1c, body mass index (BMI), and impact mental health, including stress and cognitive functioning. Trial Registration: ClinicalTrials.gov identifier: NCT04114734. Registered on October 3, 2019. • Park prescriptions are intended to increase outdoor physical activity and exposure to nature. • Study uses accelerometry to document changes in physical activity. • Targets low-income children from 6 to 16 years old • Study implemented in community health center with primary care providers. [ABSTRACT FROM AUTHOR]