A report from The Uprising – our 2025 regional roundtables event

The recent EPA Regions Roundtable brought together physiotherapists from different parts of India to examine the growing need for a region-specific approach to environmental physiotherapy. Although the global conversation around climate-responsive rehabilitation has advanced considerably, Indian physiotherapy is still in the early stages of integrating environmental determinants into clinical practice, education, and policy. The roundtable created a space for practitioners to share experiences, articulate regional challenges, and consider how environmental physiotherapy can be meaningfully shaped within the Indian context.

Discussions highlighted the country’s ecological and climatic diversity and how these factors directly influence patient presentations and rehabilitation outcomes. Physiotherapists working in hot–humid regions such as Kolkata described the constant struggle with hydration, fatigue, and reduced endurance thresholds, while those in dry-heat regions like Ahmedabad spoke of severe temperature fluctuations and prolonged heat waves that disproportionately affect neurological and geriatric populations. Air pollution in northern India adds an additional layer of complexity, contributing to systemic inflammatory burdens and reducing tolerance for physical activity and aerobic conditioning. Environmental challenges also extend beyond climate. One participant described working in a locality with documented arsenic contamination in groundwater, a long-term exposure risk associated with physical deformities and functional decline. The example underscored the broader reality that environmental determinants such as water quality, air quality, toxic exposures, and soil contamination shape the non-communicable disease landscape in which Indian physiotherapists routinely work.

A recurring theme throughout the roundtable was the recognition that physiotherapy, when grounded in movement-based, manual, educational, and behaviour-focused care, is inherently low-carbon and environmentally sustainable. However, the increasing reliance on technology-intensive, energy-consuming modalities in some urban clinics may distance practice from these strengths. Participants agreed that the foundation of environmental physiotherapy in India does not require entirely new treatment paradigms; instead, it requires reframing existing practices through an environmental lens, strengthening awareness about their long-term value, and highlighting how physiotherapy already contributes to sustainable healthcare when delivered mindfully. Leveraging on its widespread community-based rehabilitation models, India is well positioned to integrate environmentally friendly practices with relative ease.

An important segment of the discussion focused on connecting environmental physiotherapy with national policy frameworks, recognising that alignment with government initiatives strengthens credibility, institutional acceptance, and professional visibility. Participants discussed the National Action Plan on Climate Change and Human Health, which positions climate change as a significant driver of health burden and emphasises preparedness for climate-related health impacts. Although physiotherapy is not explicitly mentioned, this framework provides an opportunity to situate rehabilitation within climate-responsive care and to articulate how physiotherapists contribute to climate-related health management. A significant stride in the role physiotherapists can play was highlighted by the inclusion of one of the participants in a government project focusing on urban planning and reduction of air pollution. The LiFE (Lifestyle for Environment) Mission was also highlighted, given its emphasis on resource-conscious, sustainable living. Physiotherapy-based interventions—particularly those centred on self-management, ergonomics, physical activity, and non-pharmacological care—are naturally aligned with LiFE principles and offer a concrete way to demonstrate how rehabilitation supports national sustainability goals. The One Health Initiative further reinforces the interconnectedness of human, environmental, and ecological health and aligns conceptually with the environmental physiotherapy perspective, especially in terms of addressing shared exposures, community-level risks, and long-term effects of ecosystem changes on human well-being.

The roundtable concluded with a shared understanding that building environmental physiotherapy in India will require accessible, evidence-informed resources tailored to local realities. Participants emphasised the need to develop concise materials for the EPA Regions Page, create introductory content and region-specific considerations for clinicians, explore opportunities for collaborative publications, and contribute Indian perspectives to upcoming physiotherapy conferences. Physiopedia was identified as an important platform for disseminating information to students and early-career professionals, who may play a central role in shaping the next phase of environmentally aware physiotherapy practice.

This roundtable represents an important beginning. Although environmental physiotherapy is still emerging in India, there is clear readiness and shared commitment to develop a context-specific, policy-aligned, and evidence-based framework that reflects the environmental realities influencing patient health across the country. Continued collaboration will be essential for advancing this work and ensuring that environmental physiotherapy evolves in a way that is grounded in India’s unique strengths, challenges, and opportunities.

We started by discussing what EPT even is. We talked about how it’s a fluid concept with no fixed definition or one area, but that it’s grounded in planetary health at its core. It can be found at the intersection of environmental justice, social justice, and health justice,  incorporating all three themes. 

We were curious about what drew the attendees to EPT and this roundtable event. We found physiotherapists and students looking to connect with other therapists across Canada with similar interests and the desire to make the world and the profession better. We heard from physiotherapists who are striving to put the environment at the centre, realising that we’re all part of the environment and all in relation to each other. There was a common interest in advancing health and environmental justice in physiotherapy, and a mutual understanding that the climate crisis is the number one threat to public health globally. 

Next, we discussed what is currently happening in the area of EPT in Canada, and where people’s passions lie. Overall, we learned that there are many different areas of interest, many small initiatives (within physio but also related projects from other professions), but a lack of coordination or awareness of one another. 

Some highlighted projects include:

•  the PaRx Parks Prescription project where healthcare professionals can prescribe patients free entry to national parks (entry usually costs $9.00 CAD per adult). 

• The work of Émilie Fortin (PhD student) whose research focuses on the potential of re(connection) to the Land in rehabilitation, particularly through nature-based interventions and Indigenous ways of doing.

• The Canadian Association of Physicians for the Environment (CAPE), an active group of, mainly, physicians with a strong national presence, which could lead to fruitful collaborations. 

• Having more EPT based lectures and curricula in physiotherapy education 

• The University of Alberta’s Rehabilitation Medicine’s Student Association, spearheaded by Amir Shamsi, is leading workshops and lectures addressing and promoting equity, diversity and inclusion, including around the environment and sustainability in healthcare

• And so much more! 

The idea that there are other physiotherapists in Canada with similar interests, that there are already many related projects, small and large, and that we don’t know of each other, all made us realise that although there is an interest in EPT in Canada, there is no established community surrounding it. 

We finished by discussing the challenges around this and ways to address them. There seemed to be a consensus that we are very much a grassroots collective at the moment. As one participant said:

“My perception is that there is something going on in almost every province, but that enviro PT hasn’t entered the collective consciousness yet of the profession. It’s still a new topic for a lot of physios. I’d love to see the profile of enviro PT elevated in Canada. Then maybe we might attract more and more physios who are curious about enviro PT, and bring this into the mainstream”.