This post looks at the role that doctors play in park prescription programs, while a later follow-up will look more deeply about the contributions of park departments that have partnered with clinics.
The growing prevalence of obesity and illnesses related to inactivity underscores the importance of cooperation between the medical community and parks departments. This idea was promoted recently by Michelle Obama’s “Let’s Move” initiative, which stresses the role of the built environment in improving public health.
Some parks departments have reached out to inactive people by providing financial incentives or prizes for participation in parks and recreation programs. The Kids in Parks program in Asheville, North Carolina, offers prizes like walking sticks, nature journals, and backpacks for kids who complete trail hikes and log them online. Insurance companies have joined in – the Senior Dimensions Fit for Life Club, a program of the Health Plan of Nevada, provides free fitness programs at more than 30 park facilities in southern Nevada as part of coverage.
But what do you do if you already have a great park and recreation system but a persistently unhealthy population? The solution might be a doctor’s intervention.
Park prescription programs combine a written prescription for increased activity with guidance aimed at eliminating common barriers to outdoor exercise, such as lack of information about facilities or inability to pay for recreation programs. Such initiatives are growing in prominence across the country.
One physician-led program, called Recreation Rx, offers prescriptions that can be redeemed for free community recreation services in the San Diego area. Dr. R. Christopher Searles worked with the Chula Vista recreation director to identify existing programs for which fees could be waived and strategies to offer more free programs with existing staff and space. The program has few expenses other than the printing of prescription pads.
As it turns out, appropriate design of the prescription pads is critical to the success of the program. Dr. Searles noticed early on in the program that the prescriptions were underused, so he supplied participating clinics with wall dispensers so that the pads could be displayed more prominently. Posters were put up in the waiting room to prompt patients to ask about the program. Dr. Searles regularly meets with the recreation director to update the available activities, customizing the prescription forms for season and age range.
The prescription pads tend to be colorful, friendly, and motivational, but also must appear official if they are to be taken seriously. One program initially had patients sign the prescription along with their doctor, but later decided to only have the doctor sign the form so as to convey a greater sense of authority and significance. Some pads have suggestions of different ways to get active outdoors and for gradually increasing exercise frequency, and some programs offer prescription forms in different languages.
Doctors play an important role in tracking the programs to better understand how their recommendations are being put into action. Tracking success is not too difficult when the prescriptions are submitted as vouchers for programs. Dr. Searles found that during a three-month period, 1,304 prescriptions were dispensed and 650 were redeemed at recreation and aquatic centers. The Chicago Exercise Prescription Fitness Center Waiver, started in 2003, offers prescriptions to patients with obesity-related illnesses that can be redeemed for a free 12-week fitness center membership at any of 66 parks in Chicago. Patients must return to their doctors to renew their prescription between sessions.
Prescription Trails, a program of New Mexico Health Care Takes on Diabetes and the Albuquerque Alliance for Active Living, is focused on ensuring that patients can easily locate and access a well-maintained trail. A Parks Evaluation Committee has identified three transit-friendly, wheelchair-accessible parks for each zip code in participating communities. Volunteers evaluated local trail loops, allowing doctors to provide booklets of approved parks accompanied with ratings, amenities, and directions. Trails are periodically reviewed, and the program has worked with the city to install distance markers and make sidewalk improvements.
Portland Rx Play, which this month expanded to 23 park and recreation facilities and 24 pediatric clinics, has doctors provide the contact information of an unhealthy patient to parks and recreation staff. The goal of the physician is to create a “warm handoff” to the recreation center staff, who then take over to help identify activities that might be of interest at a nearby community center, such as karate, yoga, and “active gaming” like Wii or Dance Dance Revolution. The children involved in the program will be part of an Oregon State University study comparing the activity levels of participants with another group who are advised to exercise but not given any structured programming.
The American College of Sports Medicine has been at the forefront of this effort in the medical community, developing a program called Exercise is Medicine. It encourages doctors to include a standardized exercise evaluation with every visit and make exercise prescriptions. It is already in use by over 400 medical organizations. But is not focused specifically on encouraging park use, which raises the question of how park departments can ensure that free, public park facilities remain valuable elements of exercise prescription programs. We’ll look at some programs led by parks departments in part two of this article, coming soon.