Prescribing Outdoor Play

Two studies about how prescribing more time outdoors or in a park can help in healing process for children.

1. Outdoors Rx



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

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.


James, A.K., Hess, P., Perkins, M.E., Taveras, E.M., Scirica, C.S., (2017). Prescribing Outdoor Play: Outdoors Rx. Clinical Pediatrics, 56(6), 519-524.

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2. Park prescription (DC Park Rx): A new strategy to combat chronic disease in children



Park prescription program offers a low-cost intervention that utilizes an already-available resource to promote positive health behaviors

This article describes the development and evaluation of a Park Prescription (DC Park Rx) program for low-income residents in Washington, DC. The goal of the program was to increase the amount of physical activity in children and adolescents who are at risk for chronic illness. DC Park Rx provides pediatric health providers with a user-friendly tool to facilitate park prescriptions for families served in an outpatient clinical setting. A park prescription is a written nonmedical health-related prescription urging patients to spend more time in parks to improve their physical fitness.

A group of community volunteers (physicians, physical therapists, park rangers, and public health and physical therapy students) identified and rated over 300 parks in Washington, DC using a park-rating tool based on two established park auditing tools: Path Environment Audit Tool (PEAT) and the System for Observing Play and Recreation in Communities (SOPARC). Items on the tool addressed park cleanliness, accessibility, level of activity, amenities, and safety. A summary for each park was then developed and uploaded to a searchable database.

Participating health-care providers wrote park prescriptions for children and adolescents, as needed. The prescriptions included expectations for intensity, frequency, and duration of outside physical activity. Over a six-month period, park prescriptions were written for 225 families. Along with the prescription, each family was given a park summary handout for particular parks. Surveys were administered to parents immediately before and 3 months after their visit to the health clinic. The purpose of the survey was to assess changes in attitudes and behaviors around physical activity.

Differences in responses from pre- to post-surveys indicated that the DC Park Rx had a positive impact on study participants. The number of days per month spent in a park for 30 or more minutes increased from 7 to 8 days, and the average weekly physical activity increased from 150 to 172 minutes. Additionally, more parents believed that physical activity was important for the health of their child and made physical activity a regular focus for their family. Responses on both the pre- and post-surveys indicated that parents considered the parks to be safe and that they valued parks as places to be physically active and to enjoy nature.

These findings indicate that behaviors and attitudes relating to health and physical activity can change through a park prescription program.


Zarr, R., Cottrell, L., Merrill, C., (2017). Park prescription (DC Park Rx): A new strategy to combat chronic disease in children. Journal of Physical Activity and Health, 14(1), 1-2.


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