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Park Prescriptions is a movement to create a healthier population by strengthening the connection between the healthcare system and public lands across the country.

Download the complete 44-page report (pdf 4.2 mb)

Park Prescriptions: Resources for Good Health from the Great Outdoors

From The Institute at the Golden Gate

Parks, public health agencies, healthcare providers, and other entities across the United States are working together to promote physical activity and nutrition and improve the health of patients and the general public. Some of these partnerships have developed strategies to leverage the doctor−patient relationship to achieve this goal.

graphic of cover

Trek Ten Trails Program Crooked Lake Prairie

These programs have begun to learn what works, what deserves more study, and the institutional realities that may challenge their success. Generally, two overarching needs must be met. Healthcare practitioners need more education on the value of physical activity in nature as a powerful resource for health and more training on how to counsel and prescribe it to their patients. At the same time, parks and community programs need to tailor their communications and programs to better serve patients with a variety of health conditions— as well as the doctors making the park prescriptions.

The programs highlighted in this report represent a small but shining portion of the landscape of rapidly emerging innovation. However, the existing efforts are fragmented. By establishing mechanisms for shared communication, learning, funding, and coordination, these local efforts can be leveraged into a more impactful, cross-sector movement that improves health and well-being on a national scale.

Park Prescriptions

The goal is to increase the prescription of outdoor physical activity to prevent (or treat) health problems resulting from inactivity and poor diet. Park Prescriptions will allow visitors to public lands to increase their time spent enjoying physical activity and will also provide physicians and other healthcare providers with a new set of tools to inspire patients to improve their health. Park Prescriptions programs also benefit public lands by promoting park stewardship and increasing potential funding sources.

Despite the clear evidence that increased physical activity reduces obesity, chronic disease, and stress, the medical community seldom advises patients to increase exercise. A recent study in the American Journal of Preventive Medicine revealed that fewer than 14 percent of primary care providers regularly gave any form of counseling on exercise. Health providers, who are short on time and stretched in all directions, spend most of their clinical hours treating active disease rather than focusing on prevention

Because insurance reimbursements are geared toward treatment, there are few fi nancial incentives for healthcare providers to offer exercise and lifestyle interventions. Additionally, physicians may not know what physical activity interventions to prescribe or where to send their patients. Stronger links between the healthcare system and public lands can help the medical community promote activities that have a higher likelihood of becoming a permanent part of the patient’s life.

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Albuquerque Prescription Trails New Mexico, Prescription Pad

PROGRAMS LINKING HEALTH and PUBLIC LANDS

More and more, programs around the country are building stronger connections between health and public lands. Doctors in New Mexico and elsewhere are prescribing outdoor activity. Health insurance companies such as SeeChange Health are making commitments to reimburse patients for park visits. Cities like Chicago are investing in obesity-reducing fitness programs. Parks nationwide are making it easier for visitors to utilize trails by increasing trailhead visibility and establishing trail ratings. Because each program addresses barriers between citizens and public spaces in a unique way, creators of these programs can learn from each other. By forming a cross-sector coalition, Park Prescriptions unites health care and public lands through mutually beneficial means that serve the health of all.

KEY FINDINGS

In the research conducted for this report, the Institute has identified six key observations that guide future implementation of Park Prescriptions:

1. There is tremendous enthusiasm to link outdoor/nature-based recreation with health care.

The staff, volunteers, healthcare practitioners, and other participants in these programs are passionate about more preventive approaches to health and the use of physical activity in nature as a complement or supplement to pharmaceutical interventions. In addition to an extensive body of supporting literature, most key informants also cited examples of individual patients who improved their health because of an exercise prescription, counseling, or referral.

Programs that illustrate this finding:
■ Children and Nature Initiative
■ Prescription Trails New Mexico
■ Step Into Cuba Alliance
■ California State Parks/SeeChange Health Pilot
■ National Park Service Pilot Projects
■ Get Fit with US

2. Park programs are often easily converted to health programs.

Park-based staff, activities, materials, and initiatives— normally geared toward improving access and increasing awareness of park resources—translate well to health prescriptions programs. Many park agencies should be able to repurpose and adapt existing programs to meet the needs of healthcare practitioners who prescribe exercise.

Programs that illustrate this finding:
■ National Park Service Pilot Projects
■ Golden Gate Community Trailhead Project
■ Green Gyms

3. Many non-park programs have tools that can inform Park Prescriptions.

There are a large number of tools available from programs developed in a more traditional healthcare setting that can be applied to emerging Park Prescriptions programs. For example, SilverSneakers has developed the process for an insurance company to attract and track member participation. Exercise is Medicine has deep resources to support doctors, and the Chicago Exercise Prescription Fitness Center Waiver Program has worked out many elements of program design that are specific to urban settings.

Programs that illustrate this finding:
■ SilverSneakers
■ Exercise is Medicine
■ Chicago Exercise Prescription Fitness Center Waiver Program
■ YMCA Diabetes Prevention Program

4. Incentives increase participation.

Programs that provide incentives seem to increase participation. For example, children that return to hike additional trails on the Blue Ridge Parkway as part of the Kids in Parks program receive toys and games. Chicago residents that receive a prescription from their doctor to exercise receive a free gym membership valued at $30 to $70 depending upon their income. The Children and Nature Initiative provides Continuing Education Units (CEUs) and a small stipend for participating doctors. Most insurance companies and government programs do not reimburse a physician for time spent counseling patients or for prescribing exercise.

Programs that illustrate this finding:
■ SilverSneakers
■ Kids in Parks
■ Chicago Exercise Prescription Fitness Center Waiver Program
■ Children and Nature Initiative
■ YMCA Diabetes Prevention Program

5. There is a need for sharing lessons learned.

In many cases, programs that engineered their own tools did so with little or no knowledge of similar tools already created by other efforts around the country. For example, at least five programs created exercise prescription pads, and at least seven agencies developed different online mapping tools to help patients find trails and parks. Efforts to share materials, ideas, and lessons learned will have a large impact on the ability to improve program design and expand program reach.

6. Evaluation of Park Prescriptions is in its infancy.

There are very few Park Prescriptions programs in the United States that have been able to evaluate
effectively all elements of a program that has medical experts prescribing outdoor activity for
health.

Financial support for Park Prescriptions comes from: Golden Gate National Parks Conservancy, American Recreation
Coalition, National Park Service, Nonprofit & Public Management Center at the University of Michigan, Ross School
of Business, and SeeChange Health. The following individuals and organizations have contributed substantial in-kind
support and services: Daphne Miller, MD, Michael Suk, MD, Stephen Lockhart, MD, Cavallo Point Lodge, Grove
Consultants International, and the American Recreation Coalition.

Download the complete 44-page report (pdf 4.2 mb)

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Park Prescriptions: Resources for Good Health from the Great Outdoors