• Article
  • February 7, 2018

Doctors Prescribe Outdoor Activity With NaturePHL Program

The goal is to promote pediatric health through increased physical activity and a connection to nature.

For ages, parents have told their kids to play outside and get some fresh air. Now, a pilot program at Children's Hospital of Philadelphia (CHOP) allows doctors to further emphasize that directive—by writing a prescription for outdoor activity.

"Physical activity and outdoor recreation are priorities for doctors and patients," says Christopher Renjilian, M.D., a CHOP pediatrician and part of the team that designed the program. "But despite the fact that it's a priority for everyone, it wasn't always making it into conversations in the doctor's office."

Emphasizing nature

The program, NaturePHL, launched last year as a collaboration between CHOP, Philadelphia Parks and Recreation, the U.S. Forest Service and the Schuylkill Center for Environmental Education in Philadelphia. The initiative's aim is to promote pediatric health through increased physical activity, but not just any activity—the program encourages a connection to nature.

According to Renjilian, the benefits include:

  • Pragmatic: Studies show children naturally increase activity levels just being outdoors vs. indoors
  • Inclusive: Nature "tends to meet children where they are," allowing kids of all ages, interests and developmental stages to find activities that will engage them
  • Psychological: Being outdoors eases stress and alleviates anxiety—benefiting mental health and physical health

How it works

NaturePHL launched in August with two CHOP Care Network locations serving as the pilot sites. While pediatricians discuss the importance of outdoor activity during well visits with all patients in the target age group (5 to 12 years old), a brief questionnaire helps the doctor determine if a patient should receive a nature prescription. It's estimated that 20,000 children—about 20 percent of well visits—will receive the prescriptions in the program's first year.

Though the nature prescription wouldn't typically be followed up until the child's next well visit, the pediatrician has the option to refer the patient to a "nature navigator," a health care professional trained to counsel children and their families on the program, and help them complete their outdoor activities as prescribed.

Benefits to doctors

NaturePHL is integrated into CHOP's electronic health record system, so doctors can use the program's website to help families identify parks and green spaces near them and make a plan to spend time outdoors. Formalizing that advice with a prescription helps stress the importance of outdoor activity for patients and their parents, but NaturePHL helps prioritize it for doctors as well.

"We have so much to cover in our well visits in such a small amount of time," says Barbara Rolnick, M.D., a CHOP pediatrician. "To have this structured program to guide them—it's really a prescription for the doctor to spend a little more time explaining why this is so important, as much as it is for the patient to receive it."

Widening impact

Though it's too early to measure results from the program, Rolnick says feedback from participants has been positive. Two additional CHOP locations are expected to roll out NaturePHL later this year, reaching more children and their families.

"Part of this project is an expectation that the families will do the activities together—that's why we chose this age group," Rolnick says. "If families do these activities together, the parents are happier and healthier, too."

Send questions or comments to magazine@childrenshospitals.org.