Biodiversity and Physiotherapy

Biodiversity[edit | edit source]

Multicellular biodiversity of the Earth.

The term biodiversity refers to every living thing including humans, animals, plants and bacteria. [1] Some areas of the world are more biodiverse than others including, South Africa, Brazil, Mexico, the southwestern US and Madagascar.  Rich biodiverse areas can be threatened by pollution, population growth and climate change.  These threats can lead to species extinction, which decreases biodiversity. Scientific estimates say that it is possible that half of the species on earth could be extinct by the next century. To preserve biodiversity and protect endangered species, conservation efforts are necessary.[2]

Ecosystem[edit | edit source]

An ecosystem is a specific environment where a community of living organisms interact and live. Ecosystems can vary in size from very small to very large.[2] "Humans are an integral part of ecosystems."[3] Whether directly or indirectly, every factor within an ecosystem depends on every other factor. For example, the weather will affect which plants grow, which then affects which animals will eat those plants. Animals that do not eat those plants will have to adapt, move to another ecosystem, or die.[2]

Ecosystem Services[edit | edit source]

Ecosystem services are the benefits people derive from their ecosystems. They can be classified into:

  1. Provisioning: The products people obtain from ecosystems, such as fresh water, fuel, food, fibre and genetic resources.
  2. Regulating: The benefits people obtain from the regulation of ecosystem processes, including climate regulation, erosion control, air quality maintenance, water purification and regulation of human diseases.
  3. Cultural: The nonmaterial benefits people obtain from ecosystems through spiritual enrichment, reflection, cognitive development, recreation, and aesthetic experiences.[3]
  4. Supporting services: Help maintain all other services such as photosynthesis and pollination.[3][4]

Human Well-Being[edit | edit source]

Ecosystem services are crucial to human well-being, because they are important in influencing sustainability.[5] Five different factors encompass human well-being:[3]

  1. Basic material needs for a good life
  2. Health
  3. Good social relations
  4. Personal security
  5. Freedom and choice

Each factor supports the others either positively or negatively. Change in one facet will bring about change in another. Human well-being is particularly affected by the availability of ecosystem services. A higher supply of service allows for increased well-being whereas a lower supply decreases well-being. Increased and varied services impart communities with resource options in the face of social upheaval or natural disasters. In contrast, poorly managed ecosystems, have an increased risk of being vulnerable to drought, crop failure, flood or disease.[3] The chart below gives a synopsis of the different ecosystem services and how they relate to well-being.


Millennium Ecosystem Assessment[edit | edit source]

The demand by humans for ecosystem services is growing quickly. However, human action is concurrently altering the capacity of these systems to provide services. The Millennium Ecosystem Assessment (MA) was created to provide options for conserving the ecosystem while meeting human needs. Human well-being is the main focus of the MA framework. The MA was created in 2001 by a partnership of governments, private sectors, non-governmental organisations and scientists. Questions the MA is designed to answer include:

  • “What are the current conditions and trends of ecosystems and their associated human well-being?
  • What are the plausible future changes in ecosystems and in the supply of and demand for ecosystem services and the consequent changes in health, livelihood, security, and other constituents of well-being?
  • What can we do to enhance well-being and conserve ecosystems? What are the strengths and weaknesses of response options, actions, and processes that can be considered to realize or avoid specific futures?
  • What are the most robust findings and key uncertainties that affect the provision of ecosystem services (including the consequent changes in health, livelihood, and security) and other management decisions and policy formulations?
  • What tools and methodologies developed and used in the Millennium Ecosystem Assessment can strengthen capacity to assess ecosystems, the services they provide, their impacts on human well-being, and the implications of response options?"[3]

In the following chart, Millennium Ecosystem Assessment has shown the relationship between human well-being, biodiversity and ecosystems and how they can be altered.


Urban Lifestyles[edit | edit source]

Research shows that urban lifestyles have more immune-mediated diseases than pre-modern lifestyles. One factor researchers believe is causing the increase in immune-related diseases is the lack of biodiversity in urban communities. City living decreases microbial communities via consumption of processed food, use of antibiotics and urban pollution. This microbial imbalance has an association with immune-mediated diseases.[6][7]


Green Space Exposure[edit | edit source]

Noosa national Park, green space.

Through urbanisation, we have removed green spaces and destroyed ecosystems. Introducing new green spaces in an urban area and protecting existing ones are important because of the association to human health benefits. Research has shown that there is a wide range of health benefits associated with green space exposure:

  • Reduction in: cancer, diabetes, decreased blood pressure and cardiovascular disease.[4]
  • Improvement in: mental health, allergies[8]
  • Short term exposure: reduces stress and depressive symptoms, decreases fatigue, increases self-reported positive emotions and improves self-esteem, mood, perceived mental and physical health
  • Access to natural environments tends to enhance outdoor physical activity thereby reducing obesity and type 2 diabetes
  • Long-term exposure: (residing in) reduced respiratory, cardiovascular and cancer mortality; improved respiratory and mental health[8][7]

Physical Therapy Implications[edit | edit source]

Outdoor Gym

Biodiversity and ecosystems have implications on physiotherapists (PTs) in various ways. As discussed above, exposure to green spaces has many health benefits. As PTs, we can educate our patients on the health benefits of outdoor exposure. When discussing these benefits, PTs should inquire about any barriers the patient might have to get outdoors. Together, they can brainstorm ideas on how to add green space exposure to their normal routine. In addition, PTs can provide therapy in green space environments such as a park or an outdoor area near the clinic.[4] Should there be no green space associated with the hospital/clinic, PTs should advocate for it.  

PTs can advocate not only in their local area, but on a national or international level to improve health, ecological and social challenges. One international organisation seeking to do just that is The Environmental Physiotherapy Association. This network of students, academics and clinicians aims to advance environmental responsibility across physiotherapy practice, education and research. Environmental stewardship is a novel concept for most PTs, but with some education and understanding of how we can initiate change, PTs have an important role to play regarding the interrelation of environment and human health.[11]

Resources[edit | edit source]

References[edit | edit source]

  1. Sarkar S. Origin of the Term Biodiversity. BioScience, 2021; 71(9):893.
  2. 2.0 2.1 2.2 National Geographic. Biodiversity. Available from (2019)
  3. 3.0 3.1 3.2 3.3 3.4 3.5 Alcamo J. Ecosystems and human well-being: a framework for assessment. (2003)
  4. 4.0 4.1 4.2 Stanhope, J. Biodiversity and Physiotherapy Course. Plus. 2022
  5. Wang B, Zhang Q, Cui F. Scientific research on ecosystem services and human well-being: A bibliometric analysis. Ecological Indicators 2021;125.
  6. Roslund MI, Puhakka R, Grönroos M, Nurminen N, Oikarinen S, Gazali AM, Cinek O, Kramná L, Siter N, Vari HK, Soininen L. Biodiversity intervention enhances immune regulation and health-associated commensal microbiota among daycare children. Science advances. 2020 Oct 1;6(42):eaba2578
  7. 7.0 7.1 Oestreicher JS, Buse C, Brisbois B, Patrick R, Jenkins A, Kingsley J, Távora R, Fatorelli L. Where ecosystems, people and health meet: Academic traditons and emerging fields for research and practce. Sustentabilidade em Debate (Sustainability in Debate). 2018;9:45-65.
  8. 8.0 8.1 Aerts R, Honnay O, Van Nieuwenhuyse A. Biodiversity and human health: mechanisms and evidence of the positive health effects of diversity in nature and green spaces. British medical bulletin. 2018 Sep 1;127(1):5-22.
  9. Jebel Musa.Health Benefits of Urban Green Spaces. Available from: [last accessed 15 February 2022]
  10. Greenlife Matters. Green spaces - good for people, the community and the country. Available from: [last accessed 15 February 2022]
  11. Maric F, Griech SF, Davenport TE. Advancing environmental stewardship in physical therapy: Connect, learn, act. Cardiopulmonary Physical Therapy Journal. 2022 Jan 1;33(1):2-4.