A Prescription for Physical Activity

Dr. Robert Zarr, a pediatrician at Unity Health Care, in Washington D.C., treats his patients with weight-related issues in an atypical manner – by telling them to walk more in their communities. Zarr reported in an interview with NPR that about 40% of his patients are overweight or obese. For these patients, Zarr methodically prescribes physical activity with specifics on how to fit movement in within busy schedules. Working with the National Park Service and George Washington University’s School of Public Health, Zarr even mapped out all of the parks in the District of Columbia (380 so far), rated them based on available facilities, and compiled them into a searchable database by zip code, which can be linked to patients’ electronic medical records. Although rare in the medical profession, examples of treatment that link solutions to chronic diseases to the built environment are increasingly popping up around the country.

The city of Boston launched a program called, Prescribe-a-Bike, allowing doctors at the Boston Medical Center to write low-income patients prescriptions for the city’s bike-sharing system, “Hubway.” For just $5, low-income residents receive a helmet and an annual subscription to Hubway. In a joint statement between the mayor’s office and Boston Medical Center, Kate Walsh, chief executive of Boson Medical Center, noted that 1 in 4 low-income residents is obese, which is almost twice the rate of higher income residents. She went on to note that, “Regular exercise is key to combating this trend, and Prescribe-a-Bike is one important way our caregivers can help patients get the exercise they need to be healthy.”

Medical experts are increasingly looking to community features, such as neighborhood parks and sidewalks as crucial features that assist in boosting physical activity levels. While these features have always been recognized as desirable amenities for communities, their health-related benefits have been, until recently, understated in both the health and development communities. The Centers for Disease Control and Prevention (CDC) recently announced in its State Indicator Report on Physical Activity 2014, that physical activity among youth and adults is higher in some states than others; and overall most states have environmental supports such as sidewalks or walking paths. However, the Report goes on to say that nearly half of youth live in neighborhoods without parks or playgrounds, community centers, and walking paths or sidewalks. This means that nearly half of the children in the United States could find it difficult to participate in successful programs such as the one run by Dr. Zarr.

Continued disparities exist when looking at access to parks and sidewalks. According to the “Park Score Index” created by the Trust for Public Land, 94% of people in Minneapolis live within a 10-minute walk of a park, which contrasts a city such as, Fresno, where only 51% have the same access. As medical experts continue to identify the direct correlations between public spaces and public health, it is crucial that those shaping the built environment—designers, developers, policy makers, and community groups—grapple with and prioritize these connections, too.

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    Dr. Robert Zarr, second from right, leads a hike through a park in Washington, D.C. Photo: Diana Bowen/National Park Service
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    The Hubway bike share system in Boston. Photo: Meredith Foley/Boston Magazine.
  • Minority and lower-income people are more likely to live in neighborhoods with lower-quality sidewalks, fewer parks and recreation resources, and more danger from crime and traffic.

  • Less than half of US children meet the recommended 60 minutes of physical activity a day.