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Are health benefits of physical activity in natural environments used in primary care by general practitioners in The Netherlands?

There is a growing body of literature showing that physical activity and nature have a positive effect on people's health and well-being. Additionally literature indicates that there may even be a synergic benefit from being physically active whilst simultaneously being directly exposed to nature. This insight is used in recovery programmes for work related stress and mental health care settings. However, as primary care is usually people's first point of contact with the health care system, the greatest benefits for people's health can probably be obtained in primary health care settings. The aim of the present study is therefore to investigate to what extent general practitioners advise patients on physical activity and whether they refer to the additional health benefits of physical activity in a natural environment.

A secondary analysis was performed on a random sample of 2784 video-taped patient consultations of 100 general practitioners in The Netherlands. Many characteristics of these consultations were known on the basis of earlier analyses: diagnosis, age and sex of patient and whether or not the issue of physical activity had been brought up by either patient or doctor. First, we investigated to what extent and with which health problems advice was given concerning physical activity. Second, from these consultations, a stratified sample of 100 consultations was observed in order to investigate whether an advice was given by the general practitioner concerning the additional benefits of nature. In 26% of all consultations advice on physical activity was given by the general practitioner. Physical activity was mentioned more often in cases of vague complaints than in cases with a clear cut diagnosis. As could have been expected, physical activity was mentioned relatively frequently in cases of musculoskeletal complaints and complaints of the nervous system. The additional benefits of physical activity in natural environments was not mentioned during any of the consultations.

In conclusion, general practitioners regularly give advice on physical activity. However, they fail to mention that physical activity in nature areas might have additional health benefits. Given the fact that medical treatment is increasingly evidence based, we think the evidence for the health benefits of physical activity in nature needs to be stronger. Results from such research could eventually find their way into the guidelines of the general practitioners.     

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