Background information

• All aspects of human anatomy and function are fundamentally shaped by our relationship to the environment
• Minerals are essential elements and building blocks of the large parts of human bodies and our bones are shaped through constant interaction with gravity
• The function of our muscles and nervous system depends on energy absorbed from the environment via food, air, and other sources
• The primary function of our joints is to set us in relation to the environment around us, whether it is to reach a place we want to get to, shake somebody’s hand, or lead a spoon to our mouth
• This can be acknowledged in teaching about human anatomy and function to provide a broader perspective on the body

Supporting literature

Gomes, C., & Rautureau, M. (Eds.)(2021). Minerals latu sensu and Human Health. Springer. https://doi.org/10.1007/978-3-030-65706-2

Richter, R., & Maric, F. (2022). Ecological Bodies and Relational Anatomies: Toward a Transversal Foundation for Planetary Health Education. Challenges, 13(2), 39. https://doi.org/10.3390/challe13020039

Ruggiu, A., & Cancedda, R. (2015). Bone mechanobiology, gravity and tissue engineering: effects and insights. Journal of Tissue Engineering and Regenerative Medicine, 9(12), 1339–1351. https://doi.org/10.1002/term.1942

Contributing author

For questions about the content in this specific set please contact Filip Maric (PhD), UiT The Arctic University of Norway. 

Background information

• In many countries, climate change is resulting in greater levels of heat strain for workers and other people undertaking physical activity during hot and humid months
• This is particularly so in natural environments where the ambient temperature and humidity are not controlled. In such contexts, core temperature and sweat loss in humans can rapidly rise and exceed safe levels, necessitating strategies to address these concerns and so manage risks of heat illness, heat injuries and, in worst-case scenarios, heat-related deaths
• Simply taking a break from physical activity and resting in the shade is unlikely to reduce high core temperatures to safer levels within acceptable time frames. In some instances, core temperatures continue to rise despite such rest breaks
• Human thermoregulatory mechanisms, alone, are frequently unable to adequately reverse core temperature rises in conditions of high heat stress, which are becoming more common with climate change
• Active cooling and preventive strategies are therefore becoming more important to manage risks to health and to worker productivity and athletic performance

Supporting literature

Brearley, M., Berry, R., Hunt, A. P., & Pope, R. (2023). A Systematic Review of Post-Work Core Temperature Cooling Rates Conferred by Passive Rest. Biology, 12(5), 695. https://doi.org/10.3390/biology12050695

Hall, A., Horta, A., Khan, M. R., & Crabbe, R. A. (2022). Spatial analysis of outdoor wet bulb globe temperature under RCP4. 5 and RCP8. 5 scenarios for 2041–2080 across a range of temperate to hot climates. Weather and Climate Extremes, 35, 100420.  https://doi.org/10.1016/j.wace.2022.100420

Hunt, A.P., Brearley, M., Hall, A., & Pope R. (2023). Climate change effects on the predicted heat strain and labour capacity of outdoor workers in Australia. International Journal of Environmental Research and Public Health, 20, 5675. https://doi.org/10.3390/ijerph20095675

Contributing author

For questions about the content in this specific set please contact Prof Rod Pope, Charles Sturt University, Australia.

Background information

• Oxygen makes up 60% of our body mass – far more than carbon – and our ability to obtain oxygen from the atmosphere means we are intrinsically connected to our local environment and the wider ecosystem that maintains the conditions conducive to organic life
• Because breathing is a process of exchange, it dissolves the fictional boundary between what we think of as ‘inside’ the body, and what is ‘outside’. After all, when does an oxygen molecule actually become part of ‘me’?
• Thinking about oxygen, air and breathing as more than just anatomical, physiological and biomedical issues allows us to imagine a broader role for physical therapies that might follow the path of air into questions about things like urban pollution, deforestation and algal blooms, as well as the meaning of breath in different world cultures. Clearly, it is more than just about pulmonary function and the treatment for chronic lung disease
• So breathing also offers a critique of the traditional belief that physical therapies should be confined to narrow Western biomedical ideals; opening a door to thinking radically about a different future for the profession

Supporting literature

Maric, F., & Nicholls, D. A. (2022). Environmental physiotherapy and the case for multispecies justice in planetary health. Physiotherapy Theory and Practice, 38(13), 2295–2306. https://doi.org/10.1080/09593985.2021.1964659

Nicholls, D. A. (2019). What’s real is immaterial: What are we doing with new materialism? Aporia: The nursing journal, 11(2), 3-13. http://hdl.handle.net/10292/13056

Richter, R., & Maric, F. (2022). Ecological Bodies and Relational Anatomies: Toward a Transversal Foundation for Planetary Health Education. Challenges, 13(2), 39. https://doi.org/10.3390/challe13020039

Contributing author

For questions about the content in this specific set please contact Prof David Nicholls, AUT University Auckland, New Zealand. 

Background information

• The International Classification of Function (ICF) compartmentalised the patient together with the patient’s condition into the multiple factors that impact the overall wellbeing of the patient
• The ICF is used when evaluating disability and health and it considers the patient’s body structures and function, activities and participation, environmental and personal factors in the holistic management of the patient’s condition
• Climate and other environmental change may be considered in the context of ICF environmental factors that facilitate or inhibit patients function, activity and participation to improve physiotherapy management plans

Supporting literature

Gaskin, C. J., Taylor, D., Kinnear, S., Mann, J., Hillman, W., & Moran, M. (2017). Factors Associated with the Climate Change Vulnerability and the Adaptive Capacity of People with Disability: A Systematic Review. Weather, Climate, and Society, 9(4), 801–814. https://doi.org/10.1175/wcas-d-16-0126.1

Humpel, N. (2002). Environmental factors associated with adults’ participation in physical activity A review. American Journal of Preventive Medicine, 22(3), 188–199. https://doi.org/10.1016/s0749-3797(01)00426-3

Noreau, L., & Boschen, K. (2010). Intersection of Participation and Environmental Factors: A Complex Interactive Process. Archives of Physical Medicine and Rehabilitation., 91(9), S44–S53. https://doi.org/10.1016/j.apmr.2009.10.037

Contributing author:

For questions about the content in this specific set please contact Mahitsonge Nomusa Ntinga, University of Cape Town, South Africa.

Background information

• Clinical reasoning (CR) is an essential skill of physiotherapists and refers to the conscious and unconscious cognitive operations to integrate information pertaining to a patient’s unique circumstances
• CR can include diagnostic, therapeutic or narrative and tends to relate to the biopsychosocial model. It should incorporate wider holistic and contextual factors which include environmental considerations as these have significant potential to be implicated as causes of adverse health and barriers to improvement, they may coincide with factors relating to health inequalities
• Novice and experienced clinicians may use different models of CR but should strive for personalised, prioritised problem lists and shared decision making unique to the situation
• Tools to support clinical reasoning, for example concept maps and vector diagrams might help prompt clinicians to consider environmental contextual factors and support people to reflect on the impact and influence of environmental concerns and factors related to their health condition, activity, participation and QoL, more research is needed in this area

Supporting literature

Montpetit-Tourangeau, K., Dyer, J.-O., Hudon, A., Windsor, M., Charlin, B., Mamede, S., & Van Gog, T. (2017). Fostering clinical reasoning in physiotherapy: comparing the effects of concept map study and concept map completion after example study in novice and advanced learners. BMC Medical Education, 17(1). https://doi.org/10.1186/s12909-017-1076-z

Cruz, E. B., Caeiro, C., & Pereira, C. (2014). A narrative reasoning course to promote patient-centred practice in a physiotherapy undergraduate programme: a qualitative study of final year students. Physiotherapy Theory and Practice, 30(4), 254–260. https://doi.org/10.3109/09593985.2013.863415

Huhn, K., Gilliland, S.J., Black, L.L., Wainwright, S.F., Christensen, N. (2018) Clinical reasoning in physical therapy: A concept analysis. Physical Therapy, 99(4):440-456. https://doi.org/10.1093/ptj/pzy148

Contributing author

For questions about the content in this specific set please contact Dr Katherine Cook, University of Winchester, UK.

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• Active transport can be a powerful means to achieve the WHO physical activity recommendations
• At scale and in combination with public transport, it can also significantly reduce greenhouse gas emissions in urban transport
• Active transport should be recommended for all commutes under 5km
• Teaching about physical activity and exercise prescription can easily include knowledge and skills relevant to the promotion of active transport as a clinical planetary health intervention.

Supporting literature

Bull, F. C., Al-Ansari, S. S., Biddle, S., Borodulin, K., Buman, M. P., Cardon, G., Carty, C., Chaput, J.-P., Chastin, S., Chou, R., Dempsey, P. C., Dipietro, L., Ekelund, U., Firth, J., Friedenreich, C. M., Garcia, L., Gichu, M., Jago, R., Katzmarzyk, P. T., … Willumsen, J. F. (2020). World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine, 54(24), 1451–1462. https://doi.org/10.1136/bjsports-2020-10295

Salvo, D., Garcia, L., Reis, R. S., Stankov, I., Goel, R., Schipperijn, J., Hallal, P. C., Ding, D., & Pratt, M. (2021). Physical Activity Promotion and the United Nations Sustainable Development Goals: Building Synergies to Maximize Impact. Journal of Physical Activity and Health, 18(10), 1163–1180. https://doi.org/10.1123/jpah.2021-0413

Toner, A., Lewis, J. S., Stanhope, J., & Maric, F. (2021). Prescribing active transport as a planetary health intervention – benefits, challenges and recommendations. Physical Therapy Reviews, 26(3), 159–167. https://doi.org/10.1080/10833196.2021.1876598

Contributing author

For questions about the content in this specific set please contact Filip Maric (PhD), UiT The Arctic University of Norway. 

Background information

• Outdoor exercise and exposure to green and blue spaces can add many benefits to physical activity and its prescription for prevention and rehabilitation
• Variable surfaces and environments can give diverse challenges and stimulation that can contribute to the development of strength, endurance, proprioception, coordination, and overall physical health
• In addition to physical health, outdoor exercise has proven benefits for mental health and is increasingly showing potential to reduce the global burden of pain
• Teaching about physical activity and exercise prescription can easily include knowledge and skills relevant to the promotion of outdoor exercise as a planetary health intervention

Supporting literature

Kondo, M. C., Oyekanmi, K. O., Gibson, A., South, E. C., Bocarro, J., & Hipp, J. A. (2020). Nature Prescriptions for Health: A Review of Evidence and Research Opportunities. International Journal of Environmental Research and Public Health, 17(12), 4213. https://doi.org/10.3390/ijerph17124213

Stanhope, J., Breed, M. F., & Weinstein, P. (2020). Exposure to greenspaces could reduce the high global burden of pain. Environmental Research, 187, 109641. https://doi.org/10.1016/j.envres.2020.109641

Stanhope, J., Maric, F., Rothmore, P., & Weinstein, P. (2023). Physiotherapy and ecosystem services: improving the health of our patients, the population, and the environment. Physiotherapy Theory and Practice, 39(2), 227–240. https://doi.org/10.1080/09593985.2021.2015814

Contributing author

For questions about the content in this specific set please contact Filip Maric (PhD), UiT The Arctic University of Norway. 

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• Severe and prolonged heat waves, temperature variability, forest fires, consequent air pollution and floods are clear signs of climate changes
• Besides harming the planet these also put respiratory health at risk and increase morbidity and mortality among patients with chronic health diseases
• An even more alarming impact concerns antenatal air pollution exposure
• Maternal exposure to tobacco or fossil fuel-generated air pollutants causes in-utero growth retardation, lung remodelling and immune cell activation increasing the risk of developing asthma or respiratory infections, which seems to contribute to childhood origins of chronic obstructive lung disease by changing the ability for normal lung development and repair

Supporting literature

Voynow, J. A., & Auten, R. (2015). Environmental Pollution and the Developing Lung. Clinical pulmonary medicine, 22(4). https://doi.org/10.1097/cpm.0000000000000095

Bernstein, A. S., & Rice, M. B. (2013). Lungs in a Warming World. Chest., 143(5), 1455–1459. https://doi.org/10.1378/chest.12-2384

Shah, P. S., & Balkhair, T. (2011). Air pollution and birth outcomes: A systematic review. Environment International, 37(2), 498–516. https://doi.org/10.1016/j.envint.2010.10.009

Contributing author

For questions about the content in this specific set please contact Andrea Ribeiro, ISAVE Instituto Superior de Saúde, Portugal.

Background information

• Environmental factors such as exposure to biomass, fossil fuels, metals and indoor and outdoor air pollution, have a key role on the development of COPD and acute exacerbations
• These pollutants damage the airways by increasing bronchial activity, airway oxidative stress and inflammation
• Additionally exposure to these pollutants has also been found to increase hospital admission due to acute exacerbations
• Addressing air pollution is therefore an indispensable healthcare measure related to COPDs and acute exacerbations

Supporting literature

Dransfield, M., Stolz, D., & Kleinert, S. (2019). Towards eradication of chronic obstructive pulmonary disease: a Lancet Commission. The Lancet , 393(10183), 1786–1788. https://doi.org/10.1016/S0140-6736(19)30950-X

Ko, F. W. S., & Hui, D. S. C. (2012). Air pollution and chronic obstructive pulmonary disease. Respirology, 17(3), 395–401. https://doi.org/10.1111/j.1440-1843.2011.02112.x

Souto-Miranda, S., Gonçalves, A.-C., Valente, C., Freitas, C., Sousa, A. C. A., & Marques, A. (2020). Environmental Awareness for Patients with COPD Undergoing Pulmonary Rehabilitation: Is It of Added Value? International Journal of Environmental Research and Public Health, 17(21), 7968. https://doi.org/10.3390/ijerph17217968

Contributing author

For questions about the content in this specific set please contact Andrea Ribeiro, ISAVE Instituto Superior de Saúde, Portugal.

Background information

• People spend most of the time in confined environments, such as home, offices among others
• In indoors environments, the concentration of air pollutants may be too high due to thermal insulation to reduce heat loss and also due to scarce ventilation, thus reducing indoor air quality
• Studies have reported associations between asthma symptoms and indoor sources of chemical pollutants among others, such as volatile organic compounds, gas appliances or even exposure to tobacco smoke
• This makes it ever more important to address indoor environments to ensure good pulmonary health

Supporting literature

Hahad, O., Daiber, A., & Münzel, T. (2023). Physical activity in polluted air: an urgent call to study the health risks. The Lancet Planetary Health, 7(4), e266–e267. https://doi.org/10.1016/s2542-5196(23)00055-4

Hulin, M., Simoni, M., Viegi, G., & Annesi-Maesano, I. (2012). Respiratory health and indoor air pollutants based on quantitative exposure assessments. European Respiratory Journal, 40(4), 1033–1045. https://doi.org/10.1183/09031936.00159011

Li, J., Sun, S., Tang, R., Qiu, H., Huang, Q., Mason, T., & Tian, L. (2016). Major air pollutants and risk of COPD exacerbations: a systematic review and meta-analysis. International Journal of Chronic Obstructive Pulmonary Disease, Volume 11, 3079–3091. https://doi.org/10.2147/copd.s122282

Contributing author

For questions about the content in this specific set please contact Andrea Ribeiro, ISAVE Instituto Superior de Saúde, Portugal.

Background information

• All aspects of the cardiovascular system are affected by the relationship to the environment, including climate change.
• As climate change makes heat waves more frequent and more intense, cardiovascular morbidity and mortality rates increase.
• Potential pathophysiological mechanisms underlying heat impact include increased cardiac load, reduced blood pressure, prothrombotic conditions and systemic inflammatory responses.
• Physiotherapists have a crucial role in cardiac rehabilitation, helping patients to avoid the impacts of heat waves as best as possible, and preparing them to face climate change through personal and structural interventions.

Supporting literature

Liu, J., Varghese, B. M., Hansen, A., Zhang, Y., Driscoll, T., Morgan, G., Dear, K., Gourley, M., Capon, A., & Bi, P. (2022). Heat exposure and cardiovascular health outcomes: a systematic review and meta-analysis. The Lancet Planetary Health, 6(6), e484–e495. https://doi.org/10.1016/s2542-5196(22)00117-6

Gostimirovic, M., Novakovic, R., Rajkovic, J., Djokic, V., Terzic, D., Putnik, S., & Gojkovic-Bukarica, L. (2020). The influence of climate change on human cardiovascular function. Archives of environmental & occupational health, 75(7), 406-414. https://doi.org/10.1080/19338244.2020.1742079

Peters, A., & Schneider, A. (2021). Cardiovascular risks of climate change. Nature Reviews Cardiology, 18(1), 1–2. https://doi.org/10.1038/s41569-020-00473-5

Contributing author:

For questions about the content in this specific set please contact Andrea Ribeiro, ISAVE Instituto Superior de Saúde, Portugal and Mathijs Wicherson, Hogeschool Utrecht, Netherlands

Background information

• Short-term exposure to increased concentrations of air pollutants, such as fine inhalable particles from construction sites, unpaved roads, fields, smokestacks or fires, can trigger severe cardiovascular-related problems such as heart attacks.
• Longer-term exposure can lead to increased risk of cardiovascular mortality and decreases in life expectancy or even death.
• Understanding the role of air pollution in cardiovascular disease is essential for physiotherapists wishing to improve the prevention and rehabilitation of cardiovascular problems.

Supporting literature

Brook, R. D., Franklin, B., Cascio, W., Hong, Y., Howard, G., Lipsett, M., Luepker, R., Mittleman, M., Samet, J., Smith, S. C., & Tager, I. (2004). Air Pollution and Cardiovascular Disease. Circulation, 109(21), 2655–2671. https://doi.org/10.1161/01.cir.0000128587.30041.c8

Berg, Z. K., Rodriguez, B., Davis, J., Katz, A. R., Cooney, R. V., & Masaki, K. (2019). Association Between Occupational Exposure to Pesticides and Cardiovascular Disease Incidence: The Kuakini Honolulu Heart Program. Journal of the American Heart Association, 8(19). https://doi.org/10.1161/jaha.119.012569 

Zeliger, H. I. (2013). Lipophilic chemical exposure as a cause of cardiovascular disease. Interdisciplinary Toxicology, 6(2), 55–62. https://doi.org/10.2478/intox-2013-0010

Contributing author

For questions about the content in this specific set please contact Andrea Ribeiro, ISAVE Instituto Superior de Saúde, Portugal

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• Physical, social, symbolic, and cultural characteristics of an environment may invite, permit, or inhibit a reciprocal transaction between the immediate environment and the active child’s engagement in diversified motor behaviours (walking to school, performing a motor task, practising a sports activity, etc.).
• These child–environment interactions result from the emergence of diversified types of affordances, such as those in the motor category.
• Physiotherapists must consider the central role of the environment in facilitating or limiting motor skills development in children.

Supporting literature

Helldén, D., Andersson, C., Nilsson, M., Ebi, K. L., Friberg, P., & Alfvén, T. (2021). Climate change and child health: a scoping review and an expanded conceptual framework. The Lancet Planetary Health, 5(3), E164-E175. https://doi.org/10.1016/s2542-5196(20)30274-6

Flores, F. S., Rodrigues, L. P., Copetti, F., Lopes, F., & Cordovil, R. (2019). Affordances for motor skill development in home, school, and sport environments: A narrative review. Perceptual and Motor Skills, 126(3), 366-388. https://doi.org/10.1177/0031512519829271

Ward, J. S., Duncan, J. S., Jarden, A., & Stewart, T. (2016). The impact of children’s exposure to greenspace on physical activity, cognitive development, emotional wellbeing, and ability to appraise risk. Health & Place, 40, 44-50. https://doi.org/10.1016/j.healthplace.2016.04.015

Contributing author

For questions about the content in this specific set please contact Vilma Dudoniene. Lithuanian Sports University and Maria do Rosário Martins, ISAVE, Portugal

Background information

• Youth growing up in places with more greenspaces have better developmental outcomes.
• Early childhood development is a strong predictor of health and wellbeing throughout the life course.
• Neighbourhood public green and blue spaces are related to lower motor development deficits and decreased motor development deficits
• Physiotherapists should stimulate a clinical approach in green spaces improving social interaction and better developmental outcomes.

Supporting literature

Kabisch, N., Alonso, L., Dadvand, P., & van den Bosch, M. (2019). Urban natural environments and motor development in early life. Environmental research, 179, 108774. https://doi.org/10.1016/j.envres.2019.108774

Kabisch, N., Haase, D., & Annerstedt Van Den Bosch, M. (2016). Adding Natural Areas to Social Indicators of Intra-Urban Health Inequalities among Children: A Case Study from Berlin, Germany. International Journal of Environmental Research and Public Health, 13(8), 783. https://doi.org/10.3390/ijerph13080783

Sprague, N. L., Bancalari, P., Karim, W., & Siddiq, S. (2022). Growing up green: a systematic review of the influence of greenspace on youth development and health outcomes. Journal of exposure science & environmental epidemiology, 32(5), 660–681. https://doi.org/10.1038/s41370-022-00445-6

Contributing author

For questions about the content in this specific set please contact Vilma Dudoniene. Lithuanian Sports University and Maria do Rosário Martins, ISAVE, Portugal

Background information

• Public play spaces are designed for children to develop their social and physical abilities and enrich their experience.
• Through play, children can learn various cognitive skills in a relaxing environment.
• Play is an important component in the social, emotional, intellectual, and physical development of all children.
• Although playgrounds are designed to support children’s play, children with disabilities are often unable to fully participate in playgrounds, however, all children should have the same right to play in play spaces.
• Evidence supports that greenspaces are an important environmental influence on physical activity and emotional wellbeing for children and that these can be used by physiotherapists to improve children’s development and socialization.

Supporting literature

Fernelius, C. L., & Christensen, K. M. (2017). Systematic review of evidence-based practices for inclusive playground design. Children, Youth and Environments, 27(3), 78-102. https://doi.org/10.7721/chilyoutenvi.27.3.0078   

Ward, J. S., Duncan, J. S., Jarden, A., & Stewart, T. (2016). The impact of children’s exposure to greenspace on physical activity, cognitive development, emotional wellbeing, and ability to appraise risk. Health & Place, 40, 44-50. https://doi.org/10.1016/j.healthplace.2016.04.015

Siu, K. W. M., Wong, Y. L., & Lam, M. S. (2017). Inclusive play in urban cities: a pilot study of the inclusive playgrounds in Hong Kong. Procedia engineering, 198, 169-175. https://doi.org/10.1016/j.proeng.2017.07.080

Contributing author

For questions about the content in this specific set please contact Vilma Dudoniene. Lithuanian Sports University and Maria do Rosário Martins, ISAVE, Portugal

Background information

• Menstrual hygiene products generate a significant amount of waste and economic costs associated with their destruction.
• Physiotherapists could play an important role in reducing this impact by developing different strategies, such as advising on the use of reusable menstrual hygiene products, managing menstrual pain through different physiotherapy techniques, and facilitating active strategies for coping with pain.
• More research is needed to identify data about the generated waste.

Supporting literature

Anand, U., Vithanage, M., Rajapaksha, A. U., Dey, A., Varjani, S., & Bontempi, E. (2022). Inapt management of menstrual hygiene waste (MHW): An urgent global environmental and public health challenge in developed and developing countries. Heliyon, 8(7), e09859. https://doi.org/10.1016/j.heliyon.2022.e09859

Babbar K, Martin J, Ruiz J, Parray AA, Sommer M. Menstrual health is a public health and human rights issue. Lancet Public Health 2021;2667:9–10. https://doi:10.1016/s2468-2667(21)00212-7

Kaur, R., Kaur, K., & Kaur, R. (2018). Menstrual Hygiene, Management, and Waste Disposal: Practices and Challenges Faced by Girls/Women of Developing Countries. Journal of Environmental and Public Health, 2018, 1–9. https://doi.org/10.1155/2018/1730964

Contributing author

For questions about the content in this specific set please contact Zeltia Naia Entonado, Universidade da Coruna, Spain.

Background information

• Women face unique climate change risks based on their gender for a variety of reasons, including their frequent marginalisation.
• Different forms of violence against women (emotional, physical, sexual, etc.) during and after extreme events could be related to a range of factors (patriarchal attitudes, societal norms, social dislocation, economic difficulties, and disaster reduction efforts) that could worsen during extreme weather events.
• Physiotherapists must increasingly consider how gender affects health risks, which are now further exacerbated by climate change.

Supporting literature

Natterson-Horowitz, B., Boddy, A. M., & Zimmerman, D. (2022). Female Health Across the Tree of Life: Insights at the Intersection of Women’s Health and Planetary Health. PNAS Nexus. https://doi.org/10.1093/pnasnexus/pgac044

Van Daalen, K. R., Kallesøe, S. S., Davey, F., Dada, S., Jung, L., Singh, L., Issa, R., Emilian, C. A., Kuhn, I., Keygnaert, I., & Nilsson, M. (2022). Extreme events and gender-based violence: a mixed-methods systematic review. The Lancet Planetary Health, 6(6), e504-e523. https://doi.org/10.1016/s2542-5196(22)00088-2

Van Daalen, K., Jung, L., Dhatt, R., & Phelan, A. L. (2020). Climate change and gender-based health disparities. The Lancet Planetary Health, 4(2), e44–e45. https://doi.org/10.1016/s2542-5196(20)30001-2

Contributing author

For questions about the content in this specific set please contact Zeltia Naia Entonado, Universidade da Coruna, Spain.

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• Greenspace exposure is related to less severe symptoms and lower incidence of psychopathology in children, adolescents and adults.
• Built environments lacking greenspace are predictors for depressive moods across age groups.
• Urban greenspace levels (or greenspace intervention) are positively associated with mental well-being.
• The implementation of physiotherapy should take into account the environment where physiotherapy is carried out, allowing the use of green spaces (for example yards, parks, forests).
• Home and school visits by a physiotherapist can make use of green spaces to support the mental health of rehabilitated people.

Supporting literature

Tran, I. T., Sabol, O., & Mote, J. (2022). The relationship between greenspace exposure and psychopathology symptoms: A systematic review. Biological Psychiatry Global Open Science, 2(3), 206–222. https://doi.org/10.1016/j.bpsgos.2022.01.004

Yang, B., Zhao, T., Hu, L., Browning, M. H. E. M., Heinrich, J., Dharmage, S. C., Jalaludin, B., Knibbs, L. D., Liu, X., Luo, Y., James, P., Li, S., Huang, W., Chen, G., Zeng, X., Yu, Y., & Dong, G. (2021). Greenspace and human health: An umbrella review. The Innovation, 2(4), 100164. https://doi.org/10.1016/j.xinn.2021.100164

Yijun Zhang, Suzanne Mavoa, Jinfeng Zhao, Deborah Raphael and Melody Smith. (2020) The Association between Green Space and Adolescents’ Mental Well-Being: A Systematic Review. International Journal of Environmental Research and Public Health.17(18), 6640. https://doi.org/10.3390/ijerph17186640

Contributing author:

For questions about the content in this specific set please contact Maria Maljanen, Tampere University of Applied Sciences, Finland, and Monique Vroomen – van Zutphen, Fontys Hogeschoolen, Netherlands

Background information

• Physiotherapists have an important role in identifying and supporting lonely people or those at risk of becoming so.
• Being exposed to nature is hypothesized to decrease feelings of loneliness by helping to build relationships with people and nature that can reduce stress.
• Outdoor experiences may facilitate social involvement and shared learning.

Supporting literature

Leavell, M. A., Leiferman, J. A., Gascon, M., Braddick, F., Gonzalez, J. M., & Litt, J. S. (2019). Nature-Based Social Prescribing in Urban Settings to Improve Social Connectedness and Mental Well-being: a Review. Current Environmental Health Reports, 6(4), 297–308. https://doi.org/10.1007/s40572-019-00251-7

Astell-Burt, T., Hartig, T., Eckermann, S., Nieuwenhuijsen, M., Mcmunn, A., Frumkin, H., & Feng, X. (2022). More green, less lonely? A longitudinal cohort study. International Journal of Epidemiology, 51(1), 99–110. https://doi.org/10.1093/ije/dyab089

Contributing author:

For questions about the content in this specific set please contact Maria Maljanen, Tampere University of Applied Sciences, Finland, and Monique Vroomen – van Zutphen, Fontys Hogeschoolen, Netherlands

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Background information

• Professional ethics in physiotherapy has historically been focused on the relationship between the patient and therapist.
• Because of the significant health impacts of environmental degradation, it is now necessary to integrate an environmental perspective into our understanding of ethics in physiotherapy.
• Healthcare professionals also have an ethical duty to reduce the environmental footprint of healthcare systems and services to stay true to the fundamental ethical principle of “do no harm”.
• Environmental ethics can be included in all teaching about ethics in physiotherapy.

Supporting literature

Katz, C. (2022). The Ethical Duty to Reduce the Ecological Footprint of Industrialized Healthcare Services and Facilities. The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, 47(1), 32–53. https://doi.org/10.1093/jmp/jhab037

Maric, F., & Nicholls, D. A. (2022). Environmental physiotherapy and the case for multispecies justice in planetary health. Physiotherapy Theory and Practice, 38(13), 2295–2306. https://doi.org/10.1080/09593985.2021.1964659

Wardrope, A. (2020). Health justice in the Anthropocene: medical ethics and the Land Ethic. Journal of Medical Ethics, 46(12), 791–796. https://doi.org/10.1136/medethics-2020-106855

Contributing author

For questions about the content in this specific set please contact Filip Maric (PhD), UiT The Arctic University of Norway.

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• The health impacts of climate change will be different for every individual due to their differences in exposure, sensitivity and adaptive capacity.
• Exposure is high for those living in rural areas with harsh cold temperatures or those living at the top of a block of flats in a hot city centre.
• Sensitivity is raised due to age, pre-existing medical conditions, social deprivation, isolation and marginalisation.
• Adaptive capacity can be limited in our patients with restricted mobility or impaired communication skills.
• When high exposure, sensitivity and limited adaptive capacity align individuals are vulnerable to the health impacts of climate change.
• Physiotherapy educators may encourage students to reflect on how climate change will affect the health of vulnerable patients.
• This may lead to discussions around the potentially minimal carbon footprint of vulnerable patients and be followed with carbon literacy training.

Supporting literature

Fagliano, J. A., & Diez Roux, A. V. (2018). Climate change, urban health, and the promotion of health equity. PLOS Medicine, 15(7), e1002621. https://doi.org/10.1371/journal.pmed.1002621

Khanal, S., Ramadani, L., & Boeckmann, M. (2023). Health Equity in Climate Change and Health Policies: A Systematic Review. Sustainability, 15(13), 10653. https://doi.org/10.3390/su151310653

Smith, G. S., Anjum, E., Francis, C., Deanes, L., & Acey, C. (2022). Climate Change, Environmental Disasters, and Health Inequities: The Underlying Role of Structural Inequalities. Current Environmental Health Reports, 9(1), 80–89. https://doi.org/10.1007/s40572-022-00336-w

Contributing author

For questions about the content in this specific set please contact Danielle Munford, University of Plymouth, UK.

Background information

• Health professionals including physiotherapists have a responsibility to be key agents of change in climate and health issues due to our trusted voice globally.
• Physiotherapists need to expand the therapeutic paradigm and recognize the impact of climate change as a key determinant of health and how it affects the most vulnerable first and hardest, but also develop a more just and climate-friendly health care system.
• It is our responsibility to communicate this to patients, our professional community, the public, and decision-makers and stakeholders at all levels.
• We must view this as a crucial part of our job and serve as role models, encourage patients to engage in healthy behaviours, help patients to navigate health care, redress health inequities, as well as, individually or as a professional group, engage in systems- and more political forms of advocacy, to improve individual health, influence leaders and develop policies that will help stabilize the climate and improve global human health.

Supporting literature

Luong, K. T., Kotcher, J., Miller, J., Campbell, E., Epel, E., Sarfaty, M., & Maibach, E. (2021). Prescription for healing the climate crisis: Insights on how to activate health professionals to advocate for climate and health solutions. The Journal of Climate Change and Health, 4. https://doi-org.proxy.kib.ki.se/10.1016/j.joclim.2021.100082

Duhaime, A.-C., Futernick, M., Alexander, M., Erny, B. C., Etzel, R. A., Gordon, I. O., Guinto, R., Hertelendy, A. J., Howard, C., Maki, L., Olagunju, A. T., Parker, E. R., Redvers, N., Sehgal, A., Shultz, J. M., Simidchiev, A., Torday, J. S., & Zhang, Y. (2021). Healthcare professionals need to be CCLEAR: Climate collaborators, leaders, educators, advocates, and researchers. The Journal of Climate Change and Health, 4, 100078. https://doi.org/https://doi.org/10.1016/j.joclim.2021.100078

Joel Charles, Abby N. Lois, Chirantan Mukhopadhyay, Edward Maibach, Jonathan A. Patz. (2021). Health professionals as advocates for climate solutions: A case study from Wisconsin. The Journal of Climate Change and Health, 4, 100052. https://doi.org/10.1016/j.joclim.2021.100052

Contributing author

For questions about the content in this specific set please contact Emma Swärdh, Karolinska Institute, Sweden.

Background information

• Nature-based therapy offers targeted benefits for individuals with neurological disorders.
• Preliminary research shows that exposure to natural environments can improve motor function, motor-sensory function, cognitive function, and fatigue in conditions like Parkinson’s disease, stroke, and traumatic brain injury.
• This can be acknowledged in teaching that nature-based therapy may be a valuable and holistic approach to complement traditional treatments in neurological rehabilitation, enhancing the well-being of those with neurological disorders.

Supporting literature

Corazon, S. S., Olsen, L. J., Olsen, A. M., & Sidenius, U. (2019). Nature-based therapy for people suffering from post-concussion syndrome – A pilot study. Health, 11(11), 1501. https://doi.org/10.4236/health.2019.1111113  

Pálsdóttir, A. M., Andersson, G., Grahn, P., Norrving, B., Kyrö Wissler, S., Petersson, I. F., & Pessah-Rasmussen, H. (2020). The nature stroke study; NASTRU: A randomized controlled trial of nature-based post-stroke fatigue rehabilitation. Journal of Rehabilitation Medicine, jrm00020. https://doi.org/10.2340/16501977-2652

Vibholm, A. P., Christensen, J. R., & Pallesen, H. (2020). Nature-based rehabilitation for adults with acquired brain injury: A scoping review. International Journal of Environmental Health Research, 30(6), 661-676. https://doi.org/10.1080/09603123.2019.1620183

Contributing author:

For questions about the content in this specific set please contact Aki Rintala, LAB University of Applied Sciences, Finland.

Background information

• Air pollution above a certain level predicts a higher risk of developing neurological diseases, such as Alzheimer and Parkinson’s.
• Among all air pollutants, PM2.5 is one of the most important and is emitted from various outdoor sources, such as vehicular emissions, construction sites and indoor sources such as chimneys and cooking fires.
• It often leads to premature ageing of the brain via inducing neurodegeneration.
• Physiotherapists must understand how air pollution contributes to neurodegeneration to consider preventive actions and research in neurological pathologies.

Supporting literature

Craig, L., Brook, J. R., Chiotti, Q., Croes, B., Gower, S., Hedley, A., Krewski, D., Krupnick, A., Krzyzanowski, M., Moran, M. D., Pennell, W., Samet, J. M., Schneider, J., Shortreed, J., & Williams, M. (2008). Air pollution and public health: a guidance document for risk managers. Journal of toxicology and environmental health. Part A, 71(9-10), 588–698. https://doi.org/10.1080/15287390801997732

Kim, H., Kim, W. H., Kim, Y. Y., & Park, H. Y. (2020). Air Pollution and Central Nervous System Disease: A Review of the Impact of Fine Particulate Matter on Neurological Disorders. Frontiers in public health, 8, 575330. https://doi.org/10.3389/fpubh.2020.575330

Wang, J., Ma, T., Ma, D., Li, H., Hua, L., He, Q., & Deng, X. (2021). The Impact of Air Pollution on Neurodegenerative Diseases. Therapeutic Drug Monitoring : a Journal Devoted to Therapeutic Drug Monitoring and Clinical Drug Toxicology, 43(1), 69–78. https://doi.org/10.1097/FTD.0000000000000818

Contributing author

For questions about the content in this specific set please contact Sristhi Banerjee, LJ Institute of Physiotherapy, India.

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• Intensive and acute care units (ICUs and ACUs) significantly contribute to the healthcare sector’s carbon footprint, primarily due to their round-the-clock operation, energy-intensive equipment, extensive use of disposable supplies, and waste generation.
• Health professionals, including physiotherapists, can play an important role in reducing this impact by adopting several strategies
• Strategies may include promoting energy efficiency, minimising waste, ensuring efficient use and maintenance of equipment, advocating for environmentally friendly practices, facilitating home-based therapy (tele-physiotherapy), and transitioning to digital platforms for documentation.

Supporting literature

Baid, H., & Damm, E. (2021). Reducing critical care’s carbon footprint with financial and social co-benefits. Intensive & Critical Care Nursing, 64, 103030. https://doi.org/10.1016/j.iccn.2021.103030

McGain, F., Muret, J., Lawson, C., & Sherman, J. D. (2020). Environmental sustainability in anaesthesia and critical care. British Journal of Anaesthesia, 125(5), 680–692. https://doi.org/10.1016/j.bja.2020.06.055

Muret, J., & Kelway, C. (2019). Why should anaesthesiologists and intensivists care about climate change? Anaesthesia, Critical Care & Pain Medicine, 38(6), 565–567. https://doi.org/10.1016/j.accpm.2019.10.014

Contributing author

For questions about the content in this specific set please contact António Alves Lopes, ESSAlcoitão, Portugal.

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• Physiotherapists are important stakeholders in occupational health and ergonomics.
• Undergraduate students need education about work and the work environment.
• We expect employers will increasingly seek advice from health professionals, including occupational health physiotherapists, about managing the expected impact of climate change at the workplace.
• Active transport, e.g. getting to and from work, and working outdoors will prove challenging for employees and their employers. An initial starting point for class discussion is about work-related heat stress and occupational lung disease.

Supporting literature

Borg, M. A., Xiang, J., Anikeeva, O., Pisaniello, D., Hansen, A., Zander, K., Dear, K., Sim, M. R., & Bi, P. (2021). Occupational heat stress and economic burden: A review of global evidence. Environmental Research., 195. https://doi.org/10.1016/j.envres.2021.110781

Di Corleto, R. (2019) Physical Hazards: Thermal Environment. In HaSPA (Health and Safety Professionals Alliance), The Core Body of Knowledge for Generalist OHS Professionals. Tullamarine, VIC. Safety Institute of Australia. https://www.ohsbok.org.au/wp-content/uploads/2019/11/26-Thermal-Environment-1.pdf

Feary, J., Lindstrom, I., Huntley, C. C., Suojalehto, H., & De La Hoz, R. E. (2023). Occupational lung disease: when should I think of it and why is it important?. Breathe, 19(2), 230002. https://doi.org/10.1183/20734735.0002-2023

Contributing author

For questions about the content in this specific set please contact Rose Boucaut, University of South Australia, and Charlotte Gerner, University of South Australia.

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• Active commuting (~45min/day) is associated with low levels of low-grade inflammation and more active leisure time
• Single-occupancy vehicles (SOV) transportations increase pollution, and congestion, and reduces physical activity
• People spend less time in physical activities which causes an economic burden in society by increasing the risks of type 2 diabetes and respiratory and circulatory system disorders (e.g., Finland 3,2 billion / year)
• New developments in sustainable SOV transportation (i.e., electric cars, scooters, and bikes) may provide sustainable access to long-distance environments, but they may also cause risks of less physical activity and mobility
• Physiotherapists are encouraged to support behaviour changes among citizens and persons with risks of diseases to stay active and find new ways to incorporate sustainable transportation and active lifestyle

Supporting literature

Allaouat, S., Halonen, J. I., Jussila, J. J., Tiittanen, P., Ervasti, J., Ngandu, T., … & Lanki, T. (2024). Association between active commuting and low-grade inflammation: a population-based cross-sectional study. European Journal of Public Health, 34(2), 292-298. https://doi.org/10.1093/eurpub/ckad213

Mundorf, N., Redding, C. A. & Bao, S. (2023). Sustainable transportation and health. International Journal of Environmental Research and Public Health, 15: 542. https://doi.org/10.3390/ijerph15030542

Mundorf, N., Redding, C. A., & Paiva, A. L. (2018). Sustainable transportation attitudes and health behavior change: Evaluation of a brief stage-targeted video intervention. International Journal of Environmental Research and Public health, 15(1), 150. https://doi.org/10.3390/ijerph15010150

Contributing author:

For questions about the content in this specific set please contact Aki Rintala, LAB University of Applied Sciences, Finland.

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