An on-going randomized controlled trial is examining the impact of park prescriptions on low-income pediatric patientsLow-income groups often tend to be less physically active, spend less time outdoors, and visit parks less frequently than higher income groups. Because reduced participation in physical activity among low-income populations is likely a contributing factor to health disparities, interventions that increase physical activity are greatly needed. Park prescriptions are one such approach that aims to encourage physical activity in natural settings through a formal clinical recommendation to be active outdoors. This article outlines an on-going five-year randomized controlled trial of the Park Rx intervention that is being conducted with pediatric patients at a health center that serves low-income families in Washington, DC, US. The aims of the research are to examine if park prescriptions impact pediatric patients’: 1) park visits and physical activity; 2) physical health diagnoses; and 3) mental health, including stress and cognitive functioning. The study will also explore possible age and gender differences. As a prospective study, this article only reports on the Park Rx intervention and data collection protocol; findings from the study are not yet published.
Pediatric patients (ages 6-16) with a diagnosed chronic condition, including ADHD, overweight or obesity, hypertriglyceridemia or hypercholesterolemia, pre-diabetes and Type 2 diabetes, are eligible to participate in the study. Through random assignments, 250 participants in the intervention group receive routine medical attention along with a park prescription, while 250 control group participants receive only routine medical attention. The Park Rx intervention is introduced to participants in the intervention group during their primary care visits. Healthcare providers facilitate discussions with participants and their families to identify safe places (usually parks), enjoyable outdoor activities, and establish the frequency and duration of these activities to ensure the prescription is feasible. Participants log each time they fill their park prescription and answer one or two research questions using the online Park Rx platform. At each three-month follow-up appointment throughout the 24-month study period, providers and patients review logged information, discuss the successes and challenges of the prescription, and modify prescriptions as needed. Data collection includes baseline assessments prior to the intervention and follow-up assessments at 3, 6, 12, and 24 months after the baseline for participants in both groups. Assessments collect data on participants’ moderate-to- vigorous physical activity (MVPA) measured with wearable accelerometers, body mass index (BMI), and a set of health biomarkers including cholesterol, triglycerides, and blood glucose levels. Surveys conducted by phone with both groups assess park visits and use validated assessments to measure stress and cognition (including memory, attention, and problem-solving abilities). Data will be statistically analyzed. Analysis will also examine the influence of neighborhood-level characteristics such as park quality, population density, and poverty.
The study was initiated in March 2020, during the onset of COVID-19 restrictions. Due to the closure of health clinics, recruitment and data collection methods shifted from in-person to remote recruitment and telemedicine visits. Pandemic-related restrictions may have affected providers' likelihood of prescribing park visits and families' comfort with spending time outdoors. Further, the far majority of participants are BIPOC (Black, Indigenous, people of color); because the study also coincided with an increase in racial and political unrest, families were likely deterred from spending time outdoors in public spaces due to an increased risk of having a negative encounter with law-enforcement. It is unclear how these barriers may have impacted participant's ability to fill their park prescription and how they will influence study results. Nonetheless, “the findings from this study will reflect real-world conditions and will elucidate the impact of park prescriptions on a low-income population.”
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