These prescriptions are sometimes called ‘green’ or ‘blue’ prescriptions. Can you define these terms?

Green or blue prescriptions are also known as nature prescriptions or nature-based social prescriptions.

They involve a health professional referring a person to non-clinical services that attend to the social determinants of health, which clinical strategies alone cannot reach.

In the case of nature prescriptions, the non-clinical services are parks, woodlands, ravines or botanic gardens.

The idea is that these ‘ecosystem services’ align with personal interests to maximise intrinsic motivation and make behavioural change feel achievable and rewarding.

It might be lots of hill walking, taking the dog for a stroll, cycling or simply signing off from social media.

Research shows that if we increase the tree canopy and parkland cover near where people live and support them to get outdoors more, we can make a real dent in major health problems such as depression, diabetes and maybe even dementia.

Why should physiotherapists consider such general exercise prescriptions when patients attend for a specific clinical problem?

A health professional might speak with a patient and realise that while the standard options may relieve some aspects of the problem the patient is experiencing, they won’t get at the root causes.

Antidepressants, for example, are a treatment for depression but don’t necessarily prevent the depression from occurring.

Physiotherapists can harness nature to encourage exercise, finds Thomas Astell-Burt.

Metformin can help to control glucose in a person with type 2 diabetes, but whole-of-lifestyle change is needed to push the diabetes into remission or prevent it from happening in the first place.

The root causes could be anything from perpetual loneliness to a sense of hopelessness and despair about financial insecurity or housing affordability.

This can lead to negative thoughts, poor sleep, social withdrawal, unhealthy eating habits and declines in physical activity, even though a person knows they should try to keep up a healthy lifestyle.

Offering advice on how to keep active is great in theory, but the impacts are typically weak and short-lived.

Physiotherapists and other health professionals are powerfully positioned to harness nature in a way that actually empowers people to have better health.

What is the range of benefits that might come from exercise in green and blue spaces?

The benefits are astonishing.

Nature is an attractive and low-to-no-cost setting in which to be physically active.

Ample evidence also indicates that contact with nature can provide relief from stress and renewal of depleted cognitive abilities, enabling new connections with other people and improving the capacity for a good night’s sleep.

One of the key ways this occurs is that nature provides a source of ‘soft fascination’, in which our attention is held by a less cognitively demanding activity, such as watching leaves blowing in the wind as we walk among the trees.

Doing this repeatedly produces meaningful reductions in heart disease, hypertension, diabetes and other major non-communicable diseases.

Are there public health initiatives that tie in with this?

The key seems to be hitting at least 30 per cent green cover within a 1.6-kilometre walk of a person’s home.

Our research over the years on the supply side, focusing on the benefits of improving the availability of nearby green space, has had a big impact on greening strategies in Australia.

For instance, the recent almost $400 million 10-year strategy in Sydney in which 7000 mature trees will be planted and parks created or regenerated cited many of our studies as informing their plan for this massive investment.

Seattle, Vancouver and Barcelona have all committed to 30 per cent greening targets too.

Is there any evidence about how patients are likely to react to green prescriptions (as opposed to general exercise prescriptions)?

Last year I ran a national survey of adults in Australia and found that about 81–82 per cent would be interested in receiving a nature prescription from a health professional.

Getting out into nature has widespread appeal and may be an effective way to support people to get more physical activity into their lives.

The key now is to develop evidence-based programs, working in partnership with health professionals of all types, to make this a sustainable, effective and cost-effective option for everyone.

>> Thomas Astell-Burt is the professor of population health and environmental data science at the University of Wollongong and a founding co-director of the Population Wellbeing and Environment Research Lab (PowerLab). Follow @ProfAstellBurt on Twitter and LinkedIn.