In 1879, a physician in Elmira, New York, had a dream. He wanted to build a place where his patients could exercise. So, Dr. Edwin Eldridge purchased a tract of undeveloped wilderness land and turned it into a garden of great beauty — a world-class, Victorian-style park named Eldridge Park. He believed this park could become a place where the community would gather and people would recreate, thereby improving their health. The park stands today in Elmira as a place of beauty that still lives up to its historic traditions of improving the health of those who visit it.

Parks as medicine is not a new concept. Frederick Law Olmsted, the noted landscape architect of the 19th century, strongly believed that parks could improve people, particularly their health. He noted that overexposure to certain aspects of city life led to “nervous tension, over-anxiety, hasteful disposition, impatience [and] irritability.” Olmsted firmly believed that the green spaces in parks could benefit both physical and mental health. But, while the connection between parks and health was evident, the field of medicine traditionally focused on training physicians and healthcare providers to diagnose and treat — not prevent — disease and illness. Over time, many healthcare providers lost sight of the benefits of parks as medicine, but, today, a growing body of research is producing evidence that parks really are some of the best medicine there is.

The Movement

Prescribing parks is rapidly increasing across the United States as it is being recognized by the medical community as a low-cost intervention that utilizes a known, generally trusted and accessible resource — parks — to influence positive health outcomes. National medical organizations are supporting this notion as well. The American College of Preventive Medicine (ACPM) launched a “Lifestyle Medicine” curriculum for medical professionals that promotes healthy lifestyle behaviors (physical activity, nutrition, etc.) as a means of preventing and treating chronic diseases.

“Every patient comes with an ‘invisible backpack’ that has all the things that could be standing in the way of good health: depression, obesity, lack of education around lifestyle choices, etc.,” says Danielle Pere, associate executive director for ACPM. “Physicians are not taught enough about counseling a patient on lifestyle choices and how they impact chronic disease. We also don’t have right now a medical system that supports talking to patients about lifestyle due to time limitations and financial pressures. This curriculum helps them think about the whole person, beyond what they learned in medical school.”

As recognition of parks as medicine continues to grow, park professionals should seize the opportunity. Healthcare providers can be the strongest advocates for parks, as they look for cost-effective, impactful and fun ways to get their patients healthy. This partnership benefits not only the patients who may lack access to services and the means to improve their own health, but also the parks by increasing use and quality of programs and services.

“We Love Parks”

Medical professionals may be busy with their everyday jobs, but many of them are natural park champions. One physician from Ohio was so taken with the effects of nature that he developed his own program to walk with his patients once a week. “I came across studies all the time that show the undeniable benefits of simply being in nature,” says Dr. David Sabgir, a board-certified cardiologist who practices with Mount Carmel Clinical Cardiovascular Specialists. “Many of these benefits are related to mental health. Time in nature leads to increased ability to focus, lower rates of depression and anxiety, higher sleep quality, and the list goes on. All of these have significant, positive consequences for the heart, lungs and many other organ systems.”

Dr. Sabgir created the Walk with a Doc (WWAD) program in 2005 to encourage healthy lifestyles among patients through regular walks with their doctor at their local park or trail. Almost 250 doctors across the country, from cardiologists, family practitioners and pediatricians, to vascular surgeons and psychiatrists, are running WWAD programs. Of these programs, the most successful ones take place in parks. “The parks provide the perfect space to experience these health boosts,” Sabgir says. “Personally, I believe a 30-minute walk in the park is likely the single best thing you can do for your short- and long-term mental and physical health.”

Dr. Lourdes Forster, MD, FAAP, an associate professor of pediatrics and the medical director at UHealth Pediatrics at the Miller School of Medicine, University of Miami, was introduced to parks at a young age. “My parents emigrated from Cuba to Miami in the 1960s,” says Dr. Forster. “I was one of five kids, and I loved to play and be outside. Parks are where I went in the summer.” Today, Dr. Forster is excited to take what she experienced as a child and incorporate that into her profession. She works with Miami-Dade County Parks, Recreation and Open Spaces Department on a park prescriptions program that prescribes wellness to children using the department’s Fit2Play™ afterschool program. “For my kids — some affluent, some poor — it’s all the same for them at the park. It allows me to give them an opportunity to improve their health without feeling like there’s no way to do it.”

Joyce Blair Wilson, a family nurse practitioner and certified diabetes educator, came to Sandpoint, Idaho, to make a difference. She works with the Kaniksu Land Trust in north Idaho and northwest Montana on the “RX Parks and Trails” program and was thrilled to discover all the parks and trails available in the area. “Being part of this program has enhanced my knowledge of nature,” she says. “As a result of this program, my patients are visiting parks more!” Wilson helps her patients experience nature and become healthier by walking with 15 to 20 of them every Sunday. “Even during inclement weather, my patients prefer being outdoors rather than in an indoor, warm pool.”

“Parks Are a Resource to Us”

Agencies can enhance a provider’s ability to refer his or her patients to parks in a number of ways. Providers note that patients often do not associate neighborhood parks as a place of wellness, so more education on the health benefits of parks is needed. There is also a need for parks to help patients understand they have resources in their neighborhood. As a result of the RX Parks and Trails program, Wilson was pleased to be more well-informed about what her neighborhood has to offer. “Both my patients and I had no idea that there were so many parks and trails in the area,” she says. “I’ve lived here eight years and had never heard of our local park.”

Safety is also of utmost importance. “A few families don’t feel safe in their parks,” says Dr. Forster. “Some parks do not provide a welcoming environment, and we still struggle with finding the right match for patients.” This barrier falls on the agency to ensure that communities feel safe when accessing its facilities. “The challenge is improving the environment that we have for families. This is no small task. The trail may not be clear. Kids may be exposed to old equipment. This is hard for practitioners to know. As a physician, I need to feel secure that the program I’m sending my patients to is meeting their needs in a safe way that they’ll want to continue.”

In addition to safety, agencies can help ensure a more supportive environment, for example, as patients walk in the park. “One of our parks locks its bathrooms in the winter,” Wilson says. “This is a constant complaint I get from patients.” Ensuring facilities are user-friendly, such as clearing the trails from branches overhead or ensuring there are benches along the walking paths, will motivate patients to keep coming back. “This is really important for my older patients,” Wilson continues. “This is not just an issue of awareness that the park is there, but of getting people to use the park.”

Healthcare providers also want to learn about programs that work. “Where we see things working really well is when the park has a pre-established program that the provider can plug into,” says Pere. “The park could host a yoga day or maybe have a walking club in place that the physician can refer his or her patients to. Even a pamphlet or flyer that they can keep in their office or a list of parks in the area would help.” Dr. Forster agrees: “As physicians, we are more receptive if you approach us with a concise plan of action that has purposeful results. We are interested in finding solutions to a sedentary lifestyle, and if parks can come up with programmatic options for us and provide us with a schedule for them, there is a higher likelihood that we will adopt the plan and send our patients there. In general, doctors want something that’s accessible and safe. I wouldn’t want to refer someone to a situation that wasn’t well-run or supervised.”

“We Feel Secure in the Relationship with Our Parks”

In all relationships, trust is an important factor, and providers are looking to establish two-way communication that includes feedback and information sharing. “I feel secure in the partnership we have with Miami-Dade parks,” says Dr. Forster. “And as a result, there’s a comfort level for me to send kids to the park. We are all working together and invested in the same goal. I’m not sending my patients somewhere and never hearing back on how it went and if it improved their health.” Providers within the Miami-Dade park prescription program, Parks Rx 4 Health™, receive measurable outcomes to document patients’ progress at baseline, and at three and six months after referral. “We meet with park staff regularly — every other month,” Forster continues. “My level of comfort comes from the people I work with. I trust the park and that they’re doing their job.

“Initially, the parks came to us. We couldn’t find resources to give our families for activity and play and exercise. Most families can’t join a gym; nor would they want to. The parks had something that was accessible and available.”

What was especially helpful, Forster said, was that the parks had something that was evidence-based and was already making a positive health impact in the community. “As a healthcare provider, one of our challenges is to promote things that work. We don’t want to prescribe something that doesn’t make a difference. And, we want to do this working with people that we know are motivated to improve health.”

“We Believe in This Movement!”

Working with parks has been rewarding for many healthcare providers. “RX Parks and Trails has become an integral part of my practice,” says Wilson. “It works and is a very gratifying experience for me as a provider. One of my patients lost 30 pounds since the program started. It reversed her diabetes, and she’s not even in the pre-diabetic range now.” Dr. Forster has also seen numerous benefits. “I work with a teenage girl who was struggling with her weight a bit. She was shy, not really depressed, but we were worried she was inhibiting herself from activity due to her weight. She started walking outside with her mom in the local park, then walking after school, on her own and with friends. This evolved into exercising and eating better. She even wanted to be with her friends more. She just felt better overall.”

Dr. Sabgir sees the “greatest resilience” among his patients that walk in parks. “Parks make the immediate rewards of exercise real and provide an obvious significant added benefit. The participants at WWAD leave the park holding their head much higher and their smiles are much wider than when they arrived.” Patients who visit parks regularly “live a much higher quality of life,” he says. “The beauty of parks is that there is such incredible motivation to move. For exercise to be a realistic alternative to the couch, it has to be enjoyable.” In addition to the beauty that parks provide, parks can also help support these programs. “I found that our park was excited to have the visitors and parks around the country have provided many wonderful, useful services to our group.”

Seize the Opportunity

As the health benefits of parks become more well-known and chronic diseases continue to rise, the medical community will turn to parks as a safe, accessible and affordable way to get patients healthy right in their backyard. “For patients, the thought of going to the gym is very intimidating,” says Pere. “There’s also a cost factor, which can be a barrier for certain income levels. Physicians may not realize that some of their patients lack resources to do the basic things. That’s where parks fit in. Helping patients understand what resources have in the neighborhood is important. If it’s familiar to them, they will do it.”

Now is the time for parks to reach out to partner with healthcare providers. It’s a collaboration that has not only improved people’s health, but has also led to greater awareness of parks in the community, more users in the parks and improved access to parks. “From a physician’s standpoint, we love to partner with the community and come to the table to feel like we’re part of the community,” says Dr. Forster. Dr. Sabgir predicts that this relationship will continue. “I think that the physician ‘buy-in’ will be increasing exponentially in the coming years,” he says. “We’ve witnessed first-hand the incredible synergy that can come from these relationships. From our experience, we expect park systems will be met with excitement and gratitude as they reach out to healthcare providers and hospital systems. There are many providers out there that would love to be involved in physical activity in their local park, but aren’t quite sure how. These are sparks waiting to fly.”

Richard J. Dolesh, NRPA’s vice president of conservation and parks, contributed to this article.

Source: Parks & Recreation
June 1, 2016
By Zarnaaz Bashir, MPH