Imagine going to visit the doctor and instead of a script for medications, you leave with a Park Prescription, outlining a program of exercise and activity to be undertaken at a local park.

For many people in the United States, these park prescriptions are now part of their health care routine, with the growing recognition that outdoor physical activity has a crucial role to play in addressing chronic diseases such as type-2 diabetes, obesity, heart disease and high blood pressure.

The aim of the Park Prescriptions movement is to strengthen the connection between the healthcare system and public parks and lands, by prescribing physical activity for patients and supporting them to improve their health and wellbeing. It links health care bodies with parks organisations in an innovative cross-sector approach.

The lead organisation of the Park Prescriptions movement is the Institute at the Golden Gate in San Francisco, California. Committed to environmental sustainability through cross-sector dialogue and collaboration, the Institute’s Program Manager Kristin Wheeler manages a national initiative with more than two dozen programs.

Strategic decisions for the initiative are made by more than 40 leaders from across the United States who together work towards a common vision of establishing and promoting national standards for park prescriptions. Along with the Institute at the Golden Gate, the Leadership Team for this national initiative includes the U.S. Centers for Disease Control and Prevention (CDC) and the National Recreation and Park Association (NRPA).

As Kristin Wheeler explains, the key to developing a park prescriptions program is to have an understanding of what the barriers to participation in physical activity are and to work closely with the local community to meet its needs and aspirations.

“The most effective Park Prescriptions programs begin with a foundation rooted in the community you are working to serve and improve.

“The more buy-in you can gain from community leaders and residents the more likely you will be to create a longstanding and sustainable program,” she says.

In setting up the Bayview Hunters Point Park Prescriptions pilot program in San Francisco in 2012, the Institute undertook extensive community consultation, including 300 hours of interviews. The pilot was funded by Kaiser Permanente, which is uniquely placed as both a provider of health care and a health insurer.

“Kaiser Permanente provided funding to unresourced communities, not to their own patients,” Ms Wheeler says.

“They believe that their patients will be healthier if the whole community is healthier.”

The pilot was so successful that now the Parks Prescriptions program is being rolled out across the whole city of San Francisco.

To be part of the Park Prescriptions program requires that both medical staff and park staff undergo training for around 3 to 4 hours. Training for health care staff includes participation from parks staff and vice versa to ensure each group understands the perspective of the other and to develop the cooperative collaboration that is at the heart of the program.

“A patient is much more likely to be able to ‘fill’ their prescription if their healthcare provider can easily point them to a local park where they know a staff member will be there to greet them and guide them in getting physically active outside,” Ms Wheeler says.

“The prescription helps indicate that a relationship has been formed between the park and health worlds and that they communicate and work together to improve individuals’ lives.”

For a park to be included as part of the program certain criteria must be met and agreed upon.

“A memorandum of understanding is drawn up which includes free provision of programs at least once a month in a park,” Ms Wheeler reports.

“However, demand has been so great that all park agencies are currently offering sessions on at least a weekly basis.”

To be part of the Park Prescriptions program, exercise sessions must be free of charge, without the requirement for booking in advance; a staff member of the park must be in attendance for support and advice; and each session must run for at least 60 minutes, although some sessions run to 90 or even 120 minutes. Sessions must be consistently scheduled, so that patients know they can turn up and their activity and staff support will be available.

“The most important thing a park can offer to new users is to create a warm welcome,” Ms Wheeler explains.

“This can include making sure the park is staffed at certain times and being available to answer questions and guide new users through the features of the park.

“Making these programs consistent in time and date makes it easy for healthcare providers to prescribe patients too.”

Activities on offer vary widely according to community needs. People across the age spectrum are catered for. Fitness zones are based on demographics and try to cater for all attendees, so that adult fitness zones are incorporated near playgrounds, allowing children and their parents to exercise simultaneously.

“The types of activities offered are culturally relevant, and include Zumba classes, nature walks, and special programs for children with ADHD (Attention Deficit Hyperactivity Disorder),” Ms Wheeler says.

What has the implementation of the Parks Prescriptions program meant for the parks and recreation reserves in the San Francisco area?

“Park Prescriptions recognises that individual and community health is reliant on a healthy parks system—and that a healthy parks system is integrally linked to the value placed on it by the community.

“The most important thing we can do to preserve our parks and public lands for future generations is to ensure that they continue to be relevant for people of all ages and backgrounds. One of the ways to keep them relevant is to promote them as solutions to our health crisis.”

So Park Prescriptions can also be seen a mechanism to ensure a community’s commitment to environmental stewardship.

“We must help the public see parks as an essential value to their lives,” Ms Wheeler says.

“It has never been more important to ensure that our connection to and contributions from the natural environment are not lost. Our health, and the health of our communities, depends on it.”