Pediatricians and families respond positively to a prescription program promoting increased outdoor physical activity for children

James, A. ., Hess, P. ., Perkins, M. ., Taveras, E. ., & Scirica, C. . (2017). Prescribing Outdoor Play: Outdoors Rx. Clinical Pediatrics, 56, 519-524.

Outdoors Rx is a program designed to assist pediatric providers in promoting physical activity among their patients (age 2-13) and families by writing prescriptions linked to free, community-based outdoor activities. The program pairs exercise prescriptions issued by pediatric providers at community health centers in Boston with outdoor programs guided by the Appalachian Mountain Club. The two community health centers (CHCs) participating in this study provide care to traditionally underserved (primarily low-income) urban patient populations.

The Outdoors Rx program organizes weekly guided outdoor activities for children and their families in parks and nature preserves accessible by public transportation. Examples of program activities include nature walks, sports activities, and unstructured playtime at the beach. Outdoors Rx also provides families with online and paper information about other outdoor activities they can do on their own.

Approximately six months after the implementation of Outdoors Rx, the CHC pediatricians were asked to complete a survey about the program. The survey collected information about (a) pediatrician referral patterns to Outdoors Rx, (b) impact of Outdoors Rx on provider physical activity counseling, (c) perceived patient interest in Outdoors Rx, (d) barriers to success, and (e) suggestions for program improvement. Twenty-eight surveys were distributed to pediatric physicians participating in the Outdoors Rx project. Twenty-thee physicians completed the survey: six full-time pediatricians, 13 part-time pediatricians, 3 pediatric residents, and one who did not identify their role.

Most of the respondents (78.3%) reported feeling well-informed about Outdoors Rx, and all had prescribed the program to their patients. The number of written prescriptions, however, varied widely between providers. Nearly half of the providers had prescribed more than 20 Outdoor Rx prescriptions, 5 had prescribed between 10 and 20, and 8 had prescribed between 1 and 10. Providers were more likely to indicate that they “always” or “usually” prescribed the program to overweight or obese children than to healthy weight children. Most of the providers described the program as a useful counseling tool, and more than half said that Outdoors Rx increased their rate of physical activity counseling. Pediatricians reported strong interest in Outdoors Rx among their patients' families and cited fun, free, local, and potential for weight loss as reasons families were interested in the program. The most common reasons for not being interested were lack of time and transportation. This finding is consistent with other research indicating that low-income and minority children are less likely to have access to open space and recreational facilities than other groups of children. This inequality, in turn, may place low-income children at greater risk of obesity and related health problems.

Exercise prescription programs, such as Outdoors Rx, can be a useful tool pediatricians can use to promote increased outdoor physical activity for their patients.

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