Prescribing Parks for Improved Health Outcomes: National Park Rx Day 2018

By Justin Cutler | Posted on April 25, 2018

National Park Rx Day

On National Park Rx Day, this Sunday, April 29, communities across the country will celebrate in local and national parks with events such as Walk with a Doc, Zumba in the Park and Tai Chi to recognize the impact parks have on our health, particularly in combating preventable disease.

The National Recreation and Park Association highlighted the health benefits of parks in this infographic, and researchers found that physical activity prescriptions for parks or community recreation centers improve health outcomes for program participants. The City of Westminster in Colorado has seen the success of physical activity prescription programs firsthand.

Westminster is a suburban community nestled between Denver and Boulder with over 50 parks and 100 miles of trails. The city is particularly proud of the 43 underpasses along the trails that contribute to their ease of use. In addition, the city has over 280,000 square feet of recreation space spread across six community recreation centers.

The most recent Community Health Needs Assessment (CHNA) in Westminster found that 24.7 percent of adults were obese, and 38.1 percent were overweight. These percentages are much higher than the state averages of 20.2 percent and 35.3 percent, respectively. The CHNA recommended a community-based Healthy Eating Active Living (HEAL) intervention, so the City of Westminster and several partners established the “Rx for Health” program to reduce the number of obese and overweight people in the city.

Run by Westminster’s Recreation Division, Rx for Health is a physical activity prescription program designed to improve the handoff from the medical office to the recreation center to advance health outcomes and track results. The program partnered with one provider when it began in 2016, and over the course of the year, partnerships expanded to include 10 providers, including large providers such as Kaiser Permanente and Centura Health, along with mental health providers, independent practices, public health and community-based health clinics.

The Rx for Health program was based on the experience of Justin Cutler, Recreation Services Manager of Westminster, who had previously implemented similar interventions in Seaside and La Pine, Oregon. Cutler worked with local hospitals to prescribe physical activity to improve health outcomes and increase participation at community recreation centers. Through his work across the last eight years he has found that the most important aspect to any physical activity prescription program is the handoff. When a health care provider tells a patient that they need to be more active or else they may face greater health consequences, patients often do not know where to begin.

The Rx for Health program is a work-flow intervention designed to solve this problem. The medical provider “prescribes” physical activity to the patient and remits a prescription to the local recreation center. The local recreation center staff follows up with the patient and offers the patient a tour and free access for the patient and the patient’s entire family for one month. During the tour the recreation center staff also offers the patient access to the National Diabetes Prevention Program or targeted programming designed to address the patient’s specific disease. To date the city has completed three cohorts, and based on the evaluation conducted by the Westminster Medical Clinic, participants reported an increase in health literacy and reductions in body mass index (BMI) and H1AC levels.

Currently, Westminster is working to expand the program by leveraging electronic health records to conduct targeted recruitments to the city’s arthritis programs. Through a pilot program sponsored by the National Recreation and Park Association, Westminster and three pilot providers are working together to identify patients with arthritis and then send recruitment material to evidence-based programs (e.g. Walk with Ease, Fit & Strong, and Active Living Every Day) hosted in a community setting at the city’s recreation centers. The hypothesis is that through better coordination we can improve health outcomes through physical activity interventions that support physical and mental health improvements.

Throughout this process, Westminster and its partners have identified three keys to their success:

  1. Someone to refer to: The referral from the medical provider should be sent to a single point of contact either through email or fax. This not only reduces confusion on the part of the medical provider and the patient, but also allows for easier data tracking later and supports relationships between the medical provider and the recreation agency.
  2. Something to refer to: The referral from the medical provider does not need to be specific, but a specific program or intervention should be offered to the patient at the recreation center. The City of Westminster provides the National Diabetes Prevention Program and several evidence-based arthritis programs at little or no cost.
  3. Close the loop: It is important that the recreation center has the ability to report back to the provider on attendance and participation in order to support continued coaching from the medical provider. In order to create sustainability, the Rx for Health program works hard to show efficacy. Data is required to do this and as such should be an integral part of the program.

Do not let the keys to success be a barrier or an excuse for your community to start a similar Rx for Health Program. Take one step, make one call, find one partner, and begin. Partnerships between public health, parks & recreation, and medical providers make sense. Make a call today to your local parks and recreation agency and begin the conversation on improving health in your community.

For more information on the City of Westminster’s Rx for Health program, or to download a sample RX for Health prescription pad, click here

Justin Cutler is the Recreation Services Manager for the City of Westminster, Colorado

This blog was originally posted on the National Association of County and City Health Officials (NACCHO) The Essential Elements of Local Public Health blog.