Active Design: A Prescription to Move


This article first appeared in Inside ASHE magazine. Copyright 2017, American Society for Healthcare Engineering, and republished here with permission.

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What is active design? The term refers to an approach to designing new facilities or improving existing buildings with the goal of boosting users’ physical activity levels. It can be something as simple as using bright colors, improved lighting, music, or graphic design to transform a cold, dark stairwell into a fun and interactive place that people enjoy using instead of the elevator.

Why are health care organizations turning to active design solutions and physical activity amenities such as inviting stairways, fitness centers, and walking paths that integrate with community green spaces? Physical inactivity is a primary risk factor for several of the most costly chronic diseases, such as heart disease, type 2 diabetes, and obesity. About half of all adults have one or more chronic health conditions. Active design innovations adopted by health care facilities can encourage patients, visitors, and staff to engage in more active lifestyles. Active design also sends a clear message to the community that the facility is committed to health promotion.

Healthier by default

Health care facilities are in a unique position to promote physical activity defaults for healthy living. Active design innovations create opportunities for people to increase their physical activity in ways that are easy if not automatic because the design all but requires it. The degree to which health care environments—institutional buildings, streets, and public places—are designed to encourage physical activity is critical from a public health perspective. Active design can help people overcome some of the most common behavioral and environmental barriers to everyday movement and ultimately have a positive influence on community health.

Active design strategies

Examples of how health care organizations can employ active design in and around their facilities include:

Figure 1. Mural in stairwell, Kaiser Permanente—Westside Medical Center, Hillsboro, Oregon.
Figure 1. Mural in stairwell, Kaiser Permanente—Westside Medical Center, Hillsboro, Oregon.

Stairways: Health care organizations can deploy a variety of strategies that focus on stairs as a physical activity resource. Key principles are that stairways should be easy to locate, inviting, and accessible.

Motivational signage: Signs near stairwells or elevators can serve as decision prompts that remind people of the stairs and the health benefits of using them. Health care facilities also can provide signage to support transit use, including maps, infographics highlighting calories burned walking to the nearest transit stop, and digital transit information displays.

Outdoor active living spaces: Facility grounds can be designed to include walking paths or labyrinths, bicycle lanes, and green spaces for outdoor meetings and activities. Parcourse or exercise trails are an alternative to the traditional indoor gym. Appropriate lighting for outdoor active living areas is important to extend opportunities for physical activity into the evening.

Safe routes to health care: Make it easy and convenient for people of all ages to reach health care facilities by walking, wheeling, and transit.

Be bike-friendly: Make cycling a more practical and convenient transportation option by increasing bike racks and safe bike routes. Institutions also can look for opportunities to serve as a bike- sharing station, if a local program exists.

Mixed-use development: Consider locating new facilities in mixed-use settings, so people can live, work, dine, shop, and get their health care all in one place.

Figure 2. Labyrinth in the Healing Garden at Kaiser Permanente Sunnybrook Medical Center, Clackamas, Oregon.
Figure 2. Labyrinth in the Healing Garden at Kaiser Permanente Sunnybrook Medical Center, Clackamas, Oregon.

Community and staff garden: Gardening combines three important types of physical activity: strength, endurance, and flexibility. A health care facility requires little more than a dedicated plot of land, a potting shed, and a source of fresh water to start a garden for the community and staff.

Adopt-a-park: Parks in many communities go underutilized because they have fallen into disrepair and the fear of crime drives residents away. Health care facilities can protect and enhance neighborhood parks and open spaces by investing in infrastructure (e.g., landscape maintenance, proper lighting, and equipment for play areas) and organizing volunteer efforts to clean and maintain public recreation spaces.

Building code and design standard changes

Designers and architects may  not consider active-design elements because building codes sometimes create a barrier. For example, until recently, designing a place for rehabilitating patients to sit down while walking in hospital corridors was prohibited by many building codes.

“As a result of advocacy by American Society for Healthcare Engineering (ASHE) of the American Hospital Association (AHA), small rest areas of up to 50 square feet are now allowed in hospital corridors,” said Chad Beebe, AIA, deputy executive director, ASHE. “Because they believe active design elements can best be promoted by having consistency in guidelines across states, ASHE and AHA have been working to ensure that the guidelines used by regulators, designers, builders, and facility owners do not include barriers to active design innovation.”


As hospitals and health systems look both inside and outside of their facility walls to address the chronic disease epidemic, active design solutions are an additional tool in the quest to improve health. The opportunities to apply active design in health care facilities are abundant, but they may require thinking differently about the role of environmental design. Intentionally designing buildings and public spaces to encourage and enable physical activity requires architects, designers, and planners to identify and give priority to factors that can help design movement back into our daily lives.

Resources for creating active health care environments

Several resources are available to support institutions interested in implementing active design strategies, including:

Healthy hospital environment toolkit: The Centers for Disease Control and Prevention (CDC) has produced a tool for hospitals to promote physical activity among employees and visitors.

Active Design Guidelines: Promoting Physical Activity and Health in Design: This design resource was developed by a partnership of the New York City Departments of Design and Construction, Health and Mental Hygiene, Transportation, City Planning, and Office of Management and Budget, working with leading architectural and planning academics, and with help from the American Institute of Architects New York Chapter.

Figure 3. Infographic banners, like the one above, were designed by Kaiser Permanente and the American College of Sports Medicine as part of the #Rx2Move campaign to raise awareness about active design.

Prescription to Move (#Rx2Move): Kaiser Permanente and the American College of Sports Medicine have launched a thought leadership campaign that offers a variety of strategies for health care institutions to promote physical activity and to shape environments to support active living. Infographic banners, like the one shown in Figure 3, are available for use in social media to help raise awareness about the key messages of the campaign.