Few of us would argue with the idea that a stroll outside on a sunny day is a great pick-me-up. Now it seems that it may also be just what the doctor ordered.
The benefits of nature for both body and soul are finding their way to the prescription pad as more health care providers are telling their patients to take a hike -- literally.
Prescription: A Dose of Nature
Many health care researchers and practitioners say that ecotherapy (also known as green therapy, nature therapy, and earth-centered therapy) -- a term coined by pastoral counselor Howard Clinebell in his 1996 book of the same name -- can have regenerative powers, improving mood and easing anxiety, stress, and depression.
But that’s not all. Health care providers are also giving their patients “nature prescriptions” to help treat a variety of medical conditions, from post-cancer fatigue to obesity, hypertension (high blood pressure), and diabetes.
Scientists have long known that sunlight can ease depression, especially seasonal affective disorder (SAD). New research is expanding those findings. A 2007 study from the University of Essex in the U.K., for example, found that a walk in the country reduces depression in 71% of participants. The researchers found that as little as five minutes in a natural setting, whether walking in a park or gardening in the backyard, improves mood, self-esteem, and motivation.
The growing interest in ecotherapy has even given rise to academic programs, such as one begun at John F. Kennedy University, which offers a graduate-level certificate in ecotherapy, an umbrella term that includes horticultural therapy, animal-assisted therapy, time stress management, and managing “eco-anxiety.”
John F. Kennedy University ecotherapy professor Craig Chalquist, PhD, co-author of Ecotherapy: Healing with Nature in Mind, has acknowledged that ecotherapeutic methods “do not represent a cure for the woes of industrial civilization, nor can they be judged by expectations more appropriate to a body of knowledge and practice examined by many years of research.” In other words, research thus far has not proven that spending time in nature -- while admittedly part of a healthy lifestyle -- can prevent, treat, or cure any particular condition.
Still, initial indications and a growing body of research offer a “hopeful picture” of the effectiveness of ecotherapeutic practices, Chalquist says.
Back to the Garden for Breast Cancer Survivors
Kathy Helzlsouer, MD, MHS, director of the Prevention and Research Center at Mercy Medical Center in Baltimore, has long been recommending to breast cancer survivors that they get outdoors more.
For 30% to 40% of breast cancer survivors, persistent fatigue follows their treatment, says Helzlsouer. To help her patients learn how to manage this fatigue, Helzlsouer created “Be Well, Be Healthy,” a holistic program that includes tips not only on managing stress and improving diet and exercise patterns, but also on incorporating nature as part of the healing process.
“Among the frustrations we saw in our patients,” Helzlsouer says, “was that they didn’t have the energy to garden, a favorite activity for many of them.”
For people who enjoy gardening, Helzlsouer prescribes getting back outside, even if it’s starting out with five minutes of weeding. People who aren’t gardening enthusiasts are advised to find a nearby park where they can take a walk, "commune with nature," and reap the mind-body results of a relaxing setting and physical exercise.
Getting Kids on the Path to Health
Other health care providers are also finding that being in a natural environment has numerous benefits. School nurse Stacy Bosch, RN, MSN, NCSN, of the Clark County School District in Nevada, sees many students who are overweight and/or have type II diabetes. More often than not, the youngsters’ time spent outdoors is minimal.
To get the kids -- and their parents -- away from the TV and the computer and increase their physical activity in order to help control weight and blood sugar, Bosch writes a prescription for the entire family to go to one of the county’s nature areas and simply take a walk.
So far, Bosch has received positive feedback from families that have followed her prescription. “They’re excited to be doing something together that will benefit all of them,” she says.
Bosch is one of three dozen health care providers who took part in the inaugural Health Care Nature Champions training program, offered through a partnership between the U.S. Fish and Wildlife Service, National Environmental Education Foundation, and a variety of health care professionals and organizations. The idea for nature champions resulted from the 2007 Children and Nature Summit, during which U.S. Fish and Wildlife Service staff met with doctors, educators, and outdoors professionals about finding ways to overcome "nature-deficit disorder" in children. The two-year pilot project aims to improve family health by connecting children and their families with easily accessible nature sites.
Maria Brown, MD, a member of the Johns Hopkins School of Medicine's Department of Pediatrics, who also serves as an instructor at St. Agnes Hospital in Baltimore -- where one out of three children is overweight -- says that the Nature Champion program is a handy tool for prescribing a more active lifestyle for kids and their families.
“It gives health care providers a concrete, positive way to suggest their patients get more physical activity,” Brown says. “Who’s going to argue with a prescription to get outside more?” The prescriptions come with maps to nearby parks and refuges, many of which offer outdoor experiences led by park rangers and volunteers.
How Much Time
Most major medical organizations -- including the American Academy of Pediatrics and the American Heart Association -- recommend that children get at least 60 minutes of physical activity a day, Brown says.
“What the ‘Children and Nature Initiative’ is trying to advocate for is that as much of this time as possible be outside,” Brown says, adding that outdoor time is beneficial for children’s physical, cognitive, social, and emotional development.
“Most people understand the importance of getting kids moving,” says Angelique Marquez, RD, of the Children’s Heart Center in Las Vegas. Even before being trained as a Nature Champion, Marquez prescribed outdoor activity for patients who had heart disease or were at high risk with conditions such as hypertension, high cholesterol, and diabetes.
Adding Nature to Your Day
For families that don’t live near a park, there are other ways to incorporate nature into their daily lifestyle. Marquez suggests walking to school or to the store or playing on a playground.
Kids should always be supervised by a responsible adult, Brown advises, and parents should be familiar with which playgrounds are safe in their neighborhood. For playground safety tips, check the web site of the National Association for Playground Safety.
Safety is an important factor for adults, as well. Whether you’re taking an urban hike or a walk in the park, the USDA Forest Service recommends that you do the following:
- Go with a companion (or at least let someone know where and when you’ll be going)
- Keep your eye on the weather
- Wear appropriate clothing for the conditions and locale
- Be aware of your surroundings
- Especially if it’s warm outside, take along a bottle of water so you won’t become dehydrated
- Slather on the sunscreen, and, if necessary, insect repellent.
Clearing Your Mind
Being outside not only improves physical health but offers mental clarity as well, which is one reason certified sex counselor Eric Marlowe Garrison, MAEd, MSc, suggests that his clients meet him outside.
“People talk more when they’re moving,” says Garrison, who practices in New York City and Richmond, Va. “The act of physical movement triggers the mind. I can accomplish more with my clients during a 45-minute walk in Central Park than in two hours in my office.”
Garrison, who calls himself a “country boy” at heart, started taking his practice outside about five years ago. At that time, his decision was based on personal preference, but he now finds that research is backing up his instincts.
In a 2010 Japanese study of “Shinrin-yoku” (defined as “taking in the forest atmosphere, or forest bathing”), for example, researchers found that elements of the environment, such as the odor of wood, the sound of running stream water, and the scenery of the forest can provide relaxation and reduce stress; those taking part in the study experienced lower levels of cortisol, a lower pulse rate, and lower blood pressure.
For Garrison, however, the studies really don’t matter. They only confirm what he has long believed. “I can’t deny what I’m seeing with my clients,” he says. “There’s a world of benefit to being out in nature.”